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DSH330208D ST JOHNS RIVERSIDE HOSPITAL (Terminated)
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Main Details
Name
ST JOHNS RIVERSIDE HOSPITAL
Subdivision Name
HAWTHORNE CEDAR KNOLLS
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330208D
Medicare Provider Number
330208
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/21/2008
Participating Start Date
7/1/2004
Participating Approval Date
4/21/2008
Last Recertification Date
8/27/2014
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
St John's Riverside Hospital
Tara Curtin-Paloka, Vice President and Chief Nursing Officer
(914) 964-4789
Primary Contact
John Masi, Director of Pharmacy
(914) 964-4847
Addresses
Street Address
226 LINDA AVENUE
HAWTHORNE, NY 10536
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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