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DSH330188C Mount St. Mary's Hospital and Health Center (Terminated)
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Main Details
Name
Mount St. Mary's Hospital and Health Center
Subdivision Name
SPECIALTY MEDICAL SERVICES
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330188C
Medicare Provider Number
330188
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
12/9/2010
Participating Start Date
1/1/2014
Participating Approval Date
12/14/2010
Last Recertification Date
8/27/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Catholic Health System
Michael Osborne, Vice President, Finance
(716) 828-2011
Primary Contact
Laura Volz, Director of Pharmacy
(716) 298-2244
Addresses
Street Address
5320 Military Road, Suite 107
Lewiston, NY 14092
Billing Address
Mount St. Mary's Hospital and Health Center
5300 Military Road
Lewiston, NY 14092-1997
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/20/13 address changed on 11/25/13 from 1 COLOMBA DRIVE, SUITE 2,NIAGARA FALLS NY; 12/9/2010- DOC RECD TO CONFIRM ELIG DSH ADJ%
12/20/2013
12/9/2010- DOC RECD TO CONFIRM ELIG DSH ADJ%
12/14/2010
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