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DSH330033 CHENANGO MEMORIAL HOSPITAL (ToBeTerminated)
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Main Details
Name
CHENANGO MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330033
Medicare Provider Number
330033
Additional Details
Current Program Status
ToBeTerminated
Registration Date
7/15/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/12/2016
Last Recertification Date
9/5/2024
Termination Date
Termination Reason
7/1/2025
DSH percentage below statutory minimum
Contacts
Authorizing Official
Chenango Memorial Hospital, Inc.
Desiree A Axley, Vice President Finance & CFO
(607) 373-6912
Primary Contact
United Health Services Hospitals, Inc
Ryan C. Decaro, Pharmacy Business Manager
(607) 763-1838
Addresses
Street Address
179 N. BROAD ST.
NORWICH, NY 13815
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/9/10 DOC. RECD. TO CONFIRM DSH ADJ. %
03/11/2010
June 2025
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