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DSH330241U UNIVERSITY HOSPITAL (Terminated)
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Main Details
Name
UNIVERSITY HOSPITAL
Subdivision Name
Renal Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330241U
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
8/8/2014
Termination Date
Termination Reason
7/1/2015
DSH percentage below statutory minimum
Contacts
Authorizing Official
SUNY Upstate Medical University Hospital
Robert John Corona, CEO
(315) 464-4223
Primary Contact
Steven Ciullo, Director of Pharmacy
(315) 464-4215
Addresses
Street Address
University Health Care Center
90 Presidential Plaza
Syracuse, NY 13202
Billing Address
Upstate University Hospital
750 East Adams Street
Syracuse, NY 13210
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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