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DSH330005AE KALEIDA HEALTH (Terminated)
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Main Details
Name
KALEIDA HEALTH
Subdivision Name
WOMEN & CHILDRENS HOSPITAL - Sports Medicine Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330005AE
Medicare Provider Number
330005
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2015
Participating Start Date
4/1/2015
Participating Approval Date
2/27/2015
Last Recertification Date
8/30/2016
Termination Date
Termination Reason
1/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Kaleida Health
Robert Joseph Nesselbush, EVP, CFO
(716) 859-1215
Primary Contact
Kaleida Health
Daniel Ryszka, 340B Coordinator
(716) 690-2232
Addresses
Street Address
219 BRYANT ST
BUFFALO, NY 14222-2006
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
May 2025
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