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SCH330157-02 SAMARITAN MEDICAL CENTER (Terminated)
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Main Details
Name
SAMARITAN MEDICAL CENTER
Subdivision Name
A Women's Perspective OB/GYN Clinic
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH330157-02
Medicare Provider Number
330157
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/5/2017
Participating Start Date
10/1/2017
Participating Approval Date
8/4/2017
Last Recertification Date
Termination Date
Termination Reason
1/1/2018
Other
Contacts
Authorizing Official
Samaritan Medical Center
Maxine A Briggs, VP Of Fiscal Services/Chief Financial Officer
(315) 755-3605
Primary Contact
Samaritan Medical Center
Joseph Sanzone, Director of Pharmacy
(315) 785-4293
Addresses
Street Address
22567 Summit Drive., Bldg 2, Ste. C
Watertown, NY 13622
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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