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DSH330232D SETON HEALTH SYSTEM (Terminated)
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Main Details
Name
SETON HEALTH SYSTEM
Subdivision Name
Seton Internal Medicine - THE MASSRY CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330232D
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
8/28/2018
Termination Date
Termination Reason
4/1/2019
Business decision by the Covered Entity
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
147 HOOSICK STREET
TROY, NY 12180
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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