340B Drug Pricing Program Database
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DSH330197AL CANTON-POTSDAM HOSPITAL (Terminated)
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Main Details
Name
CANTON-POTSDAM HOSPITAL
Subdivision Name
CPH GOUVERNEUR MEDICAL ONCOLOGY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330197AL
Medicare Provider Number
330197
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/16/2016
Last Recertification Date
8/29/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Rochester Regional Health
Shawn Bishop, Vice President, RRH Revenue & Reimbursement
(585) 922-0056
Primary Contact
RRH
Robert Michael Scardino, 340B Pharmacy System Manager
(585) 319-6750
Addresses
Street Address
77 WEST BARNEY STREET
GOUVERNEUR, NY 13642
Billing Address
CANTON-POTSDAM HOSPITAL
50 LEROY STREET
POTSDAM, NY 13676
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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