340B Drug Pricing Program Database
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DSH330153D Ellis Hospital (Terminated)
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Main Details
Name
Ellis Hospital
Subdivision Name
Ellis - McClellan Division - Operating Room
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330153D
Medicare Provider Number
330153
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
6/12/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/21/2012
Last Recertification Date
8/19/2021
Termination Date
Termination Reason
7/1/2022
Site closure
Contacts
Authorizing Official
Ellis
Marc Mesick, CFO & VP of Finance
(518) 243-4144
Primary Contact
Ellis Hospital
Monica Quinde, Pharmacy 340B Program Manager
(518) 243-1824
Addresses
Street Address
600 McClellan Street
Schenectady, NY 12304
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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