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DSH330197E CANTON-POTSDAM HOSPITAL (Terminated)
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Main Details
Name
CANTON-POTSDAM HOSPITAL
Subdivision Name
CPH PSYCHIATRY SERVICES
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330197E
Medicare Provider Number
330197
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/13/2008
Participating Start Date
1/1/2009
Participating Approval Date
11/13/2008
Last Recertification Date
9/13/2021
Termination Date
Termination Reason
10/1/2022
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Rochester Regional Health
Hugh Thomas, Executive Vice President, Chief Administrative Officer
(585) 922-4941
Primary Contact
Rochester Regional
Karen M Kinter, Vice President of Specialty Revenue Programs
(585) 368-3537
Addresses
Street Address
50 LEROY STREET
POTSDAM, NY 13676
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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