340B Drug Pricing Program Database
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DSH330203A CROUSE HOSPITAL (Active)
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Main Details
Name
CROUSE HOSPITAL
Subdivision Name
PHYSICIAN'S OFFICE BUILDING SURGERY CENTER (POB)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330203A
Medicare Provider Number
330203
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
9/13/2023
Participating Start Date
10/1/2023
Participating Approval Date
9/13/2023
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Crouse Hospital
Kevin Randall, Chief Financial Officer
(315) 470-7589
Primary Contact
Crouse Health
Dwayne Cleveland, Manager of 340B
(315) 470-3402
Addresses
Street Address
725 IRVING AVE.
SYRACUSE, NY 13210
Billing Address
CROUSE HOSPITAL
736 IRVING AVE.
SYRACUSE, NY 13210
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 9/2/2008, terminated 1/1/2014. Reinstated 10/1/2023.
09/13/2023
1/26/10 BILL TO ADDED 4/17/09 REMOVED MEDICAID# (WAS 3360372)
09/02/2008
April 2025
April 2025
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