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DSH330033B CHENANGO MEMORIAL HOSPITAL (Active)
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Main Details
Name
CHENANGO MEMORIAL HOSPITAL
Subdivision Name
UHS PRIM CARE SHERBURNE-FAMILY PRACTICE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330033B
Medicare Provider Number
330033
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/20/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/12/2016
Last Recertification Date
9/4/2024
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
38-A CLASSIC ST
SHERBURNE, NY 13460
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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