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DSH330394T UNITED HEALTH SERVICES HOSPITALS, INC. (Terminated)
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Main Details
Name
UNITED HEALTH SERVICES HOSPITALS, INC.
Subdivision Name
REGIONAL BLOOD DISORDERS CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330394T
Medicare Provider Number
330394
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/2/2009
Participating Start Date
9/4/2009
Participating Approval Date
9/4/2009
Last Recertification Date
9/6/2023
Termination Date
Termination Reason
7/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
United Health Services Hospitals, Inc.
James Mark Smith, Vice President - Chief Financial Officer
(607) 762-3011
Primary Contact
United Health Services Hospitals, Inc
Ryan C. Decaro, Pharmacy Business Manager
(607) 763-1838
Addresses
Street Address
33-57 HARRISON STREET
JOHNSON CITY, NY 13790
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/4/12 UPDATED SUBDIV NAME (WAS REGIONAL BLOOD DISORDERS CENTER), UPDATED MAIN ADD (WAS 40 ARCH STREET, WILSON HOSPITAL); 9/1/2009 DOC RECD TO CONFIRM ELIG DSH ADJ%
04/04/2012
9/1/2009 DOC RECD TO CONFIRM ELIG DSH ADJ%
09/04/2009
April 2025
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