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DSH330197T CANTON-POTSDAM HOSPITAL (Terminated)
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Main Details
Name
CANTON-POTSDAM HOSPITAL
Subdivision Name
CPH OB/GYN Lawrence Avenue
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330197T
Medicare Provider Number
330197
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/26/2013
Last Recertification Date
9/3/2014
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Canton-Potsdam Hospital
Donna M McGregor, System CFO
(315) 261-5451
Primary Contact
Jennifer Nye, Pharmacy Director
(315) 261-5510
Addresses
Street Address
Lawrence Avenue Medical Campus
49 Lawrence Avenue
Potsdam, NY 13676
Billing Address
Canton-Potsdam Hospital
50 Leroy Street
Potsdam, NY 13676
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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