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DSH330223K MASSENA MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
MASSENA MEMORIAL HOSPITAL
Subdivision Name
BRASHER FALLS FAMILY HEALTH CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330223K
Medicare Provider Number
330223
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/4/2014
Last Recertification Date
9/7/2016
Termination Date
Termination Reason
4/1/2017
Change of covered entity type
Contacts
Authorizing Official
MASSENA MEMORIAL HOSPITAL
Patrick Facteau, CFO
(315) 769-4207
Primary Contact
MASSENA MEMORIAL HOSPITAL
Melissa Bender, Accountant
(315) 769-4312
Addresses
Street Address
3 CUDLIPP DR
BRASHER FALLS, NY 13613-4115
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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