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SCH330211-00 Claxton Hepburn Medical Center (Terminated)
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Main Details
Name
Claxton Hepburn Medical Center
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH330211-00
Medicare Provider Number
330211
Additional Details
Current Program Status
Terminated
Registration Date
10/10/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/3/2013
Last Recertification Date
8/17/2021
Termination Date
Termination Reason
4/1/2022
Change of covered entity type
Contacts
Authorizing Official
Claxton-Hepburn Medical Center
Richard Duvall, CEO
(315) 713-5237
Primary Contact
Claxton-Hepburn Medical Center
Eric Burch, 340B Coordinator
(315) 713-5235
Addresses
Street Address
214 King Street
Ogdensburg, NY 13669
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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