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DSH330246 ST. CHARLES HOSPITAL (Active)
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Main Details
Name
ST. CHARLES HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330246
Medicare Provider Number
330246
Additional Details
Current Program Status
Active
Registration Date
12/13/2010
Participating Start Date
1/1/2011
Participating Approval Date
12/13/2010
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
St. Charles Hospital
dominick pernice, COO
(631) 474-6600
Primary Contact
St. Charles Hospital
Heather Learn, Director of Pharmacy
(631) 474-6194
Addresses
Street Address
200 BELLE TERRE ROAD
PORT JEFFERSON, NY 11777
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/02/10 DOC RECD TO CONFIRM ELIG DSH ADJ %
12/13/2010
May 2025
May 2025
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