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SCH330223-06 MASSENA MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
MASSENA MEMORIAL HOSPITAL
Subdivision Name
MMH NORFOLK CLINIC
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH330223-06
Medicare Provider Number
330223
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2017
Participating Start Date
4/1/2017
Participating Approval Date
3/14/2017
Last Recertification Date
8/19/2019
Termination Date
Termination Reason
10/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
MASSENA MEMORIAL HOSPITAL
Patrick Facteau, CFO
(315) 769-4207
Primary Contact
Massena Memorial Hospital
Patricia Clary, Controller
(315) 769-4271
Addresses
Street Address
42 WEST MAIN ST
NORFOLK, NY 13667
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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