340B Drug Pricing Program Database
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DSH330047X ST. MARYS HEALTHCARE (Active)
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Main Details
Name
ST. MARYS HEALTHCARE
Subdivision Name
St. Johnsville Urgent Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330047X
Medicare Provider Number
330047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/7/2017
Participating Start Date
7/1/2017
Participating Approval Date
5/1/2017
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
St. Mary's Healthcare
Keith Waters, Vice President of Finance/CFO
(518) 770-7583
Primary Contact
St. Mary's Healthcare
Tami Wessel, 340B Program Lead
(518) 256-1163
Addresses
Street Address
7 Timmerman Avenue
St. Johnville, NY 13452
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
April 2025
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