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DSH330047E ST. MARYS HEALTHCARE (Terminated)
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Main Details
Name
ST. MARYS HEALTHCARE
Subdivision Name
Urology Health Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330047E
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
8/26/2016
Termination Date
Termination Reason
10/1/2017
Site closure
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, Senior Director of Finance
(518) 770-7583
Addresses
Street Address
425 Guy Park Avenue
Suite 104
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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