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DSH330241AL UNIVERSITY HOSPITAL (Terminated)
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Main Details
Name
UNIVERSITY HOSPITAL
Subdivision Name
Upstate Comprehensive Pain Management - CC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330241AL
Medicare Provider Number
330241
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/13/2013
Last Recertification Date
8/24/2020
Termination Date
Termination Reason
10/1/2020
Other
Contacts
Authorizing Official
SUNY Upstate Medical University Hospital
Robert John Corona, CEO
(315) 464-4223
Primary Contact
SUNY Upstate Medical University Hospital
Katie Schmidt, 340B Coordinator
(315) 464-4212
Addresses
Street Address
4900 Broad Road
Syracuse, NY 13215
Billing Address
University Hospital
750 East Adams Street
Syracuse, NY 13210
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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