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DSH330250D CHAMPLAIN VALLEY PHYSICIANS HOSPITAL (Active)
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Main Details
Name
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL
Subdivision Name
Adult Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330250D
Medicare Provider Number
330250
Outpatient Facility Provider Number
330250
Additional Details
Current Program Status
Active
Registration Date
4/14/2019
Participating Start Date
6/3/2019
Participating Approval Date
5/31/2019
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Alice Hyde Medical Center/Champlain Valley Physicians Hospital
Matej Kollar, Vice President/Chief Financial Officer
(518) 481-8065
Primary Contact
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL
MELISSA ANNE BRESNAHAN, PHARMACY AND 340B PROGRAM MANAGER
(518) 562-7911
Addresses
Street Address
23 Hammond Lane
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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Start date is now 6/3/2019.
06/03/2019
Participated starting 10/1/2014, terminated 4/1/2019. Reinstated 7/1/2019.
05/24/2019
April 2025
April 2025
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