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DSH330208AG St. John's Riverside Hospital (Terminated)
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Main Details
Name
St. John's Riverside Hospital
Subdivision Name
O/R Andrus
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330208AG
Medicare Provider Number
330208
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2012
Participating Start Date
10/27/2012
Participating Approval Date
10/26/2012
Last Recertification Date
8/27/2014
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
St John's Riverside Hospital
Tara Curtin-Paloka, Vice President and Chief Nursing Officer
(914) 964-4789
Primary Contact
John Masi, Director of Pharmacy
(914) 964-4847
Addresses
Street Address
967 North Broadway
Yonkers, NY 10701
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
May 2025
May 2025
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