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DSH330208P ST JOHNS RIVERSIDE HOSPITAL (Active)
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Main Details
Name
ST JOHNS RIVERSIDE HOSPITAL
Subdivision Name
E/R DOBBS FERRY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330208P
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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