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DSH330005AP KALEIDA HEALTH (Terminated)
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Main Details
Name
KALEIDA HEALTH
Subdivision Name
Hertel Elmwood Health Center Dermatology Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330005AP
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
9/20/2019
Termination Date
Termination Reason
10/1/2020
Site closure
Contacts
Authorizing Official
Kaleida Health
Robert Joseph Nesselbush, EVP, CFO
(716) 859-1215
Primary Contact
Kaleida Health
Wendy Ann DellaNeve, Manager 340B Program
(716) 859-8012
Addresses
Street Address
900 HERTEL AVE
BUFFALO, NY 14216-2611
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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