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SCH330157-00 SAMARITAN MEDICAL CENTER (Terminated)
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Main Details
Name
SAMARITAN MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH330157-00
Medicare Provider Number
330157
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2011
Participating Start Date
10/1/2017
Participating Approval Date
9/11/2011
Last Recertification Date
9/16/2019
Termination Date
Termination Reason
10/1/2020
Change of covered entity type
Contacts
Authorizing Official
Samaritan Medical Center
Maxine A Briggs, VP Of Fiscal Services/Chief Financial Officer
(315) 755-3605
Primary Contact
Samaritan Medical Center
Krista Ann Krull-Goss, Director of Pharmacy
(315) 785-4248
Addresses
Street Address
830 WASHINGTON STREET
WATERTOWN, NY 13601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/4/17; Participating 10/1/2011 until terminated effective 10/1/2013, reinstated effective 10/1/2017.
08/04/2017
April 2025
April 2025
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