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DSH330047F ST. MARYS HEALTHCARE (Terminated)
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Main Details
Name
ST. MARYS HEALTHCARE
Subdivision Name
Health Center at Carondelet Pavilion
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330047F
Medicare Provider Number
330047
Outpatient Facility Provider Number
330047
Additional Details
Current Program Status
Terminated
Registration Date
2/28/2012
Participating Start Date
3/7/2012
Participating Approval Date
3/7/2012
Last Recertification Date
8/24/2020
Termination Date
Termination Reason
10/1/2021
Other
Contacts
Authorizing Official
St. Mary's Healthcare
Keith Waters, Vice President of Finance/CFO
(518) 770-7583
Primary Contact
St. Mary's Healthcare
Keith Waters, Vice President of Finance/CFO
(518) 770-7583
Addresses
Street Address
380 Guy Park Avenue
Amsterdam, NY 12010
Billing Address
St. Mary's Healthcare
427 Guy Park Ave.
Amsterdam, NY 12010
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
April 2025
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