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DSH330211D CLAXTON HEPBURN MEDICAL CENTER (Terminated)
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Main Details
Name
CLAXTON HEPBURN MEDICAL CENTER
Subdivision Name
Heuvelton Health Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330211D
Medicare Provider Number
330211
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/28/2022
Participating Start Date
4/1/2022
Participating Approval Date
1/31/2022
Last Recertification Date
8/20/2024
Termination Date
Termination Reason
1/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Claxton-Hepburn Medical Center
Richard Duvall, CEO
(315) 713-5237
Primary Contact
Claxton Hepburn Medical Center
Danny Sekhon, Director of Pharmacy
(315) 713-5685
Addresses
Street Address
214 King Street
Ogdensburg, NY 13669
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (10/1/2012) until terminated effective date: (10/13/22), reinstatement effective date: (4/1/2022)
01/31/2022
June 2025
June 2025
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