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DSH330197X CANTON-POTSDAM HOSPITAL (Terminated)
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Main Details
Name
CANTON-POTSDAM HOSPITAL
Subdivision Name
CPH ORTHOPEDICS PRACTICE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330197X
Medicare Provider Number
330197
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/23/2015
Last Recertification Date
8/18/2016
Termination Date
Termination Reason
10/1/2017
Site closure
Contacts
Authorizing Official
Canton-Potsdam Hospital
Donna M McGregor, System CFO
(315) 261-5451
Primary Contact
Canton-Potsdam Hospital
DAVID SOGOIAN, DIRECTOR OF PHARMACY
(315) 261-5510
Addresses
Street Address
EJ NOBLE BUILDING
80 EAST MAIN STREET
CANTON, NY 13617
Billing Address
CANTON-POTSDAM HOSPITAL
50 LEROY STREET
POTSDAM, NY 13676
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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