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DSH330033A CHENANGO MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
CHENANGO MEMORIAL HOSPITAL
Subdivision Name
CMH DENTAL CENTER / Dental
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330033A
Medicare Provider Number
330033
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/20/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/12/2016
Last Recertification Date
9/10/2018
Termination Date
Termination Reason
10/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
Chenango Memorial Hospital, Inc.
Drake M Lamen, President & CEO / CMO
(607) 337-4113
Primary Contact
United Health Services Hospitals, Inc
William G Waldron, Director of Pharmacy
(607) 763-1835
Addresses
Street Address
32 CONKEY AVE
NORWICH, NY 13815
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/12/16 Participating 4/1/10 until 10/1/13, reinstated effective 10/1/16
08/12/2016
3/9/10 DOC. RECD. TO CONFIRM DSH ADJ. %
03/26/2010
May 2025
May 2025
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