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DSH330197N CANTON-POTSDAM HOSPITAL (Active)
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Main Details
Name
CANTON-POTSDAM HOSPITAL
Subdivision Name
CPH POTSDAM OB/GYN PRACTICE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330197N
Medicare Provider Number
330197
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/15/2012
Participating Start Date
10/27/2012
Participating Approval Date
10/25/2012
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Rochester Regional Health
Shawn Bishop, Vice President, RRH Revenue & Reimbursement
(585) 922-0056
Primary Contact
RRH
Robert Michael Scardino, 340B Pharmacy System Manager
(585) 319-6750
Addresses
Street Address
LAWRENCE AVENUE MEDICAL CAMPUS
49 LAWRENCE AVENUE
POTSDAM, NY 13676
Billing Address
Canton-Potsdam Hospital
50 Leroy St.
Potsdam, NY 13676
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
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