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SCH330136-45 MARY IMOGENE BASSETT HOSPITAL (Terminated)
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Main Details
Name
MARY IMOGENE BASSETT HOSPITAL
Subdivision Name
CENTER FOR WOUND HEALING
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH330136-45
Medicare Provider Number
330136
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/4/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/26/2017
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
CENTER FOR WOUND HEALING
4580 RT 28
MILFORD, NY 13807
Billing Address
MARY IMOGENE BASSETT HOSPITAL
ONE ATWELL ROAD
COOPERSTOWN, NY 13326
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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