340B Drug Pricing Program Database
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DSH330047AD ST. MARYS HEALTHCARE (Terminated)
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Main Details
Name
ST. MARYS HEALTHCARE
Subdivision Name
FULTON CO PROS PERSONALIZED RECOVER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330047AD
Medicare Provider Number
330047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/28/2017
Last Recertification Date
8/25/2021
Termination Date
Termination Reason
4/1/2022
Site closure
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
73N MAIN ST
GLOVERSVILLE, NY 12078-3044
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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