340B Drug Pricing Program Database
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DSH330047Y ST. MARYS HEALTHCARE (Active)
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Main Details
Name
ST. MARYS HEALTHCARE
Subdivision Name
Johnstown Pediatrics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330047Y
Medicare Provider Number
330047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/13/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/25/2017
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
700 South Perry Street
Johnstown, NY 12095
Billing Address
St. Mary's Healthcare
427 Guy Park Ave.
Amsterdam, NY 12010
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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