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DSH330197AU CANTON-POTSDAM HOSPITAL (Terminated)
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Main Details
Name
CANTON-POTSDAM HOSPITAL
Subdivision Name
CPH GENERAL SURGERY - GENERAL SURGERY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330197AU
Medicare Provider Number
330197
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/16/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/23/2018
Last Recertification Date
9/13/2021
Termination Date
Termination Reason
10/1/2022
Outpatient facility moved within the 4 walls of the parent hospital
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
50 LEROY STREET
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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