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DSH330044AT Faxton St. Luke's Healthcare (Terminated)
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Main Details
Name
Faxton St. Luke's Healthcare
Subdivision Name
Vascular Surgery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330044AT
Medicare Provider Number
330044
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/20/2016
Last Recertification Date
9/8/2020
Termination Date
Termination Reason
10/1/2021
Site closure
Contacts
Authorizing Official
MVHS Inc, DBA Wynn Hospital
Louis Aiello, Sr. VP Finance/ CFO
(315) 917-8213
Primary Contact
MVHS, Inc. DBA: Wynn Hospital
James Humphrey, AVP Finance/ Controller
(315) 801-4326
Addresses
Street Address
1676 Sunset Avenue
Utica, NY 13502
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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