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DSH330153AW Ellis Hospital (Terminated)
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Main Details
Name
Ellis Hospital
Subdivision Name
Ellis-McClellan Division - Internal Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330153AW
Medicare Provider Number
330153
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/2/2016
Last Recertification Date
8/20/2018
Termination Date
Termination Reason
4/1/2019
Site closure
Contacts
Authorizing Official
Ellis
Marc Mesick, CFO & VP of Finance
(518) 243-4144
Primary Contact
Ellis Hospital
Ross Leach, Director of Reimbursement
(518) 612-8672
Addresses
Street Address
624 McClellan Street
Schenectady, NY 12304
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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