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DSH330197K CANTON-POTSDAM HOSPITAL (Terminated)
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Main Details
Name
CANTON-POTSDAM HOSPITAL
Subdivision Name
CPH Cardiology and Surgical Services-Wilson
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330197K
Medicare Provider Number
330197
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2012
Participating Start Date
10/27/2012
Participating Approval Date
10/25/2012
Last Recertification Date
9/3/2014
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Canton-Potsdam Hospital
Donna M McGregor, System CFO
(315) 261-5451
Primary Contact
Canton-Potsdam Hospital
RICHARD D. JACOBS, VP FOR FINANCE AND CFO
(315) 261-5100
Addresses
Street Address
15 Raymond Street
Potsdam, NY 13676
Billing Address
Canton-Potsdam Hospital
50 Leroy Street
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
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