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DSH330208AL ST JOHNS RIVERSIDE HOSPITAL (Active)
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Main Details
Name
ST JOHNS RIVERSIDE HOSPITAL
Subdivision Name
Radiology Dobbs Ferry
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330208AL
Medicare Provider Number
330208
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/15/2012
Participating Start Date
10/27/2012
Participating Approval Date
10/26/2012
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
St. John's Riverside Hospital
Michael A DiGiorno, Chief Operating Officer
(914) 798-8972
Primary Contact
St John's Riverside Hospital
JANINE O'DONNELL, AVP of Pharmacy and Medical Operations
(914) 964-4827
Addresses
Street Address
128 Ashford Avenue
Dobbs Ferry, NY 10522
Billing Address
St. John's Riverside Hospital
967 N. Broadway
Yonkers, NY 10701
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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