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SCH330136-79 MARY IMOGENE BASSETT HOSPITAL (Terminated)
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Main Details
Name
MARY IMOGENE BASSETT HOSPITAL
Subdivision Name
BASSETT HEALTHCARE HERKIMER CLINIC Cancer TMNT
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH330136-79
Medicare Provider Number
330136
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2017
Participating Start Date
7/1/2017
Participating Approval Date
6/5/2017
Last Recertification Date
8/27/2019
Termination Date
Termination Reason
4/1/2020
Other
Contacts
Authorizing Official
Bassett Medical Center
William LeCates, MD, President CEO BMC
(607) 547-7600
Primary Contact
Mary Imogene Bassett Hospital
Michael A. Sweet, Director Finance Operations
(607) 547-6775
Addresses
Street Address
BASSETT HEALTHCARE HERKIMER CLINIC
321 EAST STATE STREET
HERKIMER, NY 13350
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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