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DSH330197L CANTON-POTSDAM HOSPITAL (Active)
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Main Details
Name
CANTON-POTSDAM HOSPITAL
Subdivision Name
ORTHOPEDICS AND SPORTS MEDICINE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330197L
Medicare Provider Number
330197
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/4/2021
Participating Start Date
10/6/2021
Participating Approval Date
10/6/2021
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
6119 US HIGHWAY 11
CANTON, NY 13617
Billing Address
Canton-Potsdam Hospital
50 Leroy Street
Potsdam, NY 13676
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (10/27/2012) until terminated effective date: (10/1/2021), reinstatement effective date: 10/06/21
10/06/2021
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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