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DSH330241C UNIVERSITY HOSPITAL (Terminated)
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Main Details
Name
UNIVERSITY HOSPITAL
Subdivision Name
Wound Care - CC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330241C
Medicare Provider Number
330241
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/24/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/25/2012
Last Recertification Date
8/24/2020
Termination Date
Termination Reason
10/1/2021
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
SUNY Upstate Medical University Hospital
Stuart M. Wright, Chief Financial Officer
(315) 464-5179
Primary Contact
SUNY Upstate Medical University Hospital
Katie Schmidt, 340B Coordinator
(315) 464-4212
Addresses
Street Address
4900 Broad Road
Syracuse, NY 13215
Billing Address
Upstate University Hospital
750 East Adams Street
Syracuse, NY 13210
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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