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DSH330047R ST. MARYS HEALTHCARE (Active)
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Main Details
Name
ST. MARYS HEALTHCARE
Subdivision Name
Urology Health Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330047R
Medicare Provider Number
330047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
9/14/2012
Participating Start Date
10/27/2012
Participating Approval Date
10/3/2012
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
St. Mary's Healthcare
Keith Waters, Vice President of Finance/CFO
(518) 770-7583
Primary Contact
St. Mary's Healthcare
Tami Wessel, 340B Program Lead
(518) 256-1163
Addresses
Street Address
425 Guy Park Avenue
Suite 203
Amsterdam, NY 12010
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/2/2012 – Participation start date changed from 1/1/2013 to 10/27/2012 to reflect post-Sandy public health emergency determination for the State of New York [T.Lew]
11/05/2012
April 2025
April 2025
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