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DSH330223C MASSENA MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
MASSENA MEMORIAL HOSPITAL
Subdivision Name
OB/GYN CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330223C
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
15 HOSPITAL DR
MASSENA, NY 13662
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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