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DSH330276U NATHAN LITTAUER HOSPITAL (Terminated)
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Main Details
Name
NATHAN LITTAUER HOSPITAL
Subdivision Name
Perth-Broadalbin Primary Care Center / Gastroenterology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330276U
Medicare Provider Number
330276
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/9/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/13/2015
Last Recertification Date
9/3/2020
Termination Date
Termination Reason
10/1/2021
Other
Contacts
Authorizing Official
Nathan Littauer Hospital
Michael Ostrander, Vice President-Finance & CFO
(518) 773-5480
Primary Contact
Nathan Littauer Hospital
Brenda Hammons, Pharmacy 340B Coordinator
(518) 773-5582
Addresses
Street Address
4104 State Highway 30
Perth, NY 12010
Billing Address
Nathan Littauer Hospital
99 East State Street
Gloversville, NY 12078
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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