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DSH330241AV UNIVERSITY HOSPITAL (Terminated)
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Main Details
Name
UNIVERSITY HOSPITAL
Subdivision Name
Upstate Midwifery and Gynecology - CC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330241AV
Medicare Provider Number
330241
Outpatient Facility Provider Number
330241
Additional Details
Current Program Status
Terminated
Registration Date
7/11/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/12/2014
Last Recertification Date
8/27/2018
Termination Date
Termination Reason
1/1/2019
Site closure
Contacts
Authorizing Official
SUNY Upstate Medical University Hospital
Robert John Corona, CEO
(315) 464-4223
Primary Contact
SUNY Upstate Medical University Hospital
Eric Balotin, Associate Director of Pharmacy
(315) 464-4215
Addresses
Street Address
4900 Broad Road
POB North
Suite 4H
Syracuse, NY 13215
Billing Address
Upstate University Hospital
750 E. Adams Street
Syracuse, NY 13210
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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