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DSH330232X SETON HEALTH SYSTEM (Terminated)
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Main Details
Name
SETON HEALTH SYSTEM
Subdivision Name
Massry Hyperbariatric Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330232X
Medicare Provider Number
330232
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/14/2015
Last Recertification Date
8/28/2018
Termination Date
Termination Reason
4/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
Samaritan Hospital of Troy NY
Lori Santos, CFO
(518) 525-5537
Primary Contact
Samaritan Hospital of Troy NY
JEANNE KENNICUTT, MGR AMBULATORY CARE PHARMACY SERVICES
(518) 525-6132
Addresses
Street Address
147 HOOSICK ST
Suite G
TROY, NY 12180-2393
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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