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DSH070016F Saint Mary's Hospital (Terminated)
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Main Details
Name
Saint Mary's Hospital
Subdivision Name
West Main Street Urgent Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH070016F
Medicare Provider Number
070016
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2017
Participating Start Date
4/1/2017
Participating Approval Date
3/2/2017
Last Recertification Date
9/8/2020
Termination Date
Termination Reason
4/1/2021
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Saint Mary's Hospital
Chris M Hayes, VP of Finance
(203) 709-6294
Primary Contact
Saint Francis Hospital and Medical Center
James M Harris, Regional Director of Reimbursement
(860) 714-4396
Addresses
Street Address
1312 West Main Street
Waterbury, CT 06708
Billing Address
Saint Mary's Hospital
56 Franklin Street
Waterbury, CT 06706
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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