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DSH330232A SETON HEALTH SYSTEM (Terminated)
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Main Details
Name
SETON HEALTH SYSTEM
Subdivision Name
ST. MARY'S HOSPITAL
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330232A
Medicare Provider Number
330232
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/2/2009
Participating Start Date
10/1/2009
Participating Approval Date
9/4/2009
Last Recertification Date
8/17/2016
Termination Date
Termination Reason
7/1/2017
Site closure
Contacts
Authorizing Official
Samaritan Hospital of Troy NY
Lori Santos, CFO
(518) 525-5537
Primary Contact
Samaritan Hospital of Troy NY
JEANNE KENNICUTT, MGR AMBULATORY CARE PHARMACY SERVICES
(518) 525-6132
Addresses
Street Address
1300 MASSACHUSETTS AVE
TROY, NY 12180
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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