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DSH330241R UNIVERSITY HOSPITAL (Active)
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Main Details
Name
UNIVERSITY HOSPITAL
Subdivision Name
Breast Care, Endocrine and Plastic Surgery Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330241R
Medicare Provider Number
330241
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
5/24/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/25/2012
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
SUNY Upstate Medical University Hospital
Stuart M. Wright, Chief Financial Officer
(315) 464-5179
Primary Contact
SUNY Upstate Medical University Hospital
Amanda Marzella, 340B Contract Pharmacy Manager
(315) 464-6039
Addresses
Street Address
550 Harrison Street
Suite D
Syracuse, NY 13202
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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