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SCH330136-10 MARY IMOGENE BASSETT HOSPITAL (Terminated)
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Main Details
Name
MARY IMOGENE BASSETT HOSPITAL
Subdivision Name
Otolaryngology Clinic
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH330136-10
Medicare Provider Number
330136
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/6/2017
Participating Start Date
4/1/2017
Participating Approval Date
1/6/2017
Last Recertification Date
8/16/2021
Termination Date
Termination Reason
1/1/2022
Change of covered entity type
Contacts
Authorizing Official
Bassett Healthcare Network
Paul Swinko, CFO
(607) 547-3096
Primary Contact
Bassett Healthcare Network
Russell McCall, 340B Coordinator
(607) 547-3347
Addresses
Street Address
60 River Street
Cooperstown, NY 13326
Billing Address
Mary Imogene Bassett Hospital
1 Atwell Road
Cooperstown, NY 13340
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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