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DSH330232G SETON HEALTH SYSTEM (Terminated)
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Main Details
Name
SETON HEALTH SYSTEM
Subdivision Name
STILLWATER FAMILY HEALTH CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330232G
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
351 NORTH HUDSON AVENUE
STILLWATER, NY 12170
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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