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DSH330197AR CANTON-POTSDAM HOSPITAL (Terminated)
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Main Details
Name
CANTON-POTSDAM HOSPITAL
Subdivision Name
CPH INTERNAL MEDICINE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330197AR
Medicare Provider Number
330197
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/4/2021
Participating Start Date
10/6/2021
Participating Approval Date
10/6/2021
Last Recertification Date
Termination Date
Termination Reason
10/1/2022
Other
Contacts
Authorizing Official
Rochester Regional Health
Hugh Thomas, Executive Vice President, Chief Administrative Officer
(585) 922-4941
Primary Contact
Rochester Regional
Karen M Kinter, Vice President of Specialty Revenue Programs
(585) 368-3537
Addresses
Street Address
LAWRENCE AVENUE MEDICAL CAMPUS
49 LAWRENCE AVENUE
POTSDAM, NY 13676
Billing Address
CANTON-POTSDAM HOSPITAL
50 LEROY STREET
POTSDAM, NY 13676
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (10/1/2017) until terminated effective date: (10/01/21), reinstatement effective date: (10/06/21)
10/06/2021
April 2025
April 2025
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