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DSH330047G ST. MARYS HEALTHCARE (Terminated)
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Main Details
Name
ST. MARYS HEALTHCARE
Subdivision Name
Memorial Campus
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330047G
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
4/1/2021
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
St. Mary's Healthcare
Rick Henze, Vice President of Finance/CFO
(518) 841-7435
Primary Contact
St. Mary's Healthcare
Keith Waters, Sr. Director of Finance
(518) 770-7583
Addresses
Street Address
4988 State Highway 30
Amsterdam, NY 12010
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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