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DSH330208H ST JOHNS RIVERSIDE HOSPITAL (Active)
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Main Details
Name
ST JOHNS RIVERSIDE HOSPITAL
Subdivision Name
GREENBURGH ATS & HOMELESS SHELTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330208H
Medicare Provider Number
330208
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/15/2019
Participating Start Date
10/1/2019
Participating Approval Date
7/29/2019
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
St. John's Riverside Hospital
Michael A DiGiorno, Chief Operating Officer
(914) 798-8972
Primary Contact
St John's Riverside Hospital
JANINE O'DONNELL, AVP of Pharmacy and Medical Operations
(914) 964-4827
Addresses
Street Address
30 MANHATTAN AVENUE
WHITE PLAINS, NY 10607
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating start date 7/1/2004, Termination 10/1/2015, Reinstate 10/1/2019
07/16/2019
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