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DSH330180R SAMARITAN HOSPITAL (Terminated)
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Main Details
Name
SAMARITAN HOSPITAL
Subdivision Name
TROY UROLOGICAL ASSOCIATES - Urology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330180R
Medicare Provider Number
330180
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/10/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/23/2018
Last Recertification Date
9/5/2019
Termination Date
Termination Reason
1/1/2020
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Samaritan Hospital of Troy NY
Lori Santos, CFO
(518) 525-5537
Primary Contact
Samaritan Hospital of Troy NY
JEANNE KENNICUTT, MGR AMBULATORY CARE PHARMACY SERVICES
(518) 525-6132
Addresses
Street Address
Samaritan Medical Arts Building
2231 Burdette Ave
Suite 230
Troy, NY 12180
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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