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DSH330250C CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER (Terminated)
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Main Details
Name
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER
Subdivision Name
Ology Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330250C
Medicare Provider Number
330250
Outpatient Facility Provider Number
330250
Additional Details
Current Program Status
Terminated
Registration Date
7/3/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/8/2014
Last Recertification Date
9/10/2018
Termination Date
Termination Reason
4/1/2019
DSH percentage below statutory minimum
Contacts
Authorizing Official
Alice Hyde Medical Center / Champlain Valley Physicians Hospital
Christopher Hickey, Sr. Vice President/Chief Financial Officer
(518) 481-8067
Primary Contact
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL
MELISSA ANNE BRESNAHAN, PHARMACY AND 340B PROGRAM MANAGER
(518) 562-7911
Addresses
Street Address
206 Cornelia St.
Plattsburgh, NY 12901
Billing Address
Champlain Valley Physicians Hospital
75 Beekman St.
Plattsburgh, NY 12901
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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