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DSH330208L St. John's Riverside Hospital (Terminated)
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Main Details
Name
St. John's Riverside Hospital
Subdivision Name
CAT SCAN ANDRUS
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330208L
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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