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DSH330180Z SAMARITAN HOSPITAL (Terminated)
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Main Details
Name
SAMARITAN HOSPITAL
Subdivision Name
Hildegard Medicus Cancer Center - Infusion Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330180Z
Medicare Provider Number
330180
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/9/2019
Participating Start Date
4/1/2019
Participating Approval Date
2/27/2019
Last Recertification Date
8/27/2024
Termination Date
Termination Reason
4/1/2025
Site closure
Contacts
Authorizing Official
Samaritan Hospital of Troy NY
Lori Santos, CFO
(518) 525-5537
Primary Contact
Samaritan Hospital
Dario Pantano, Pharmacy Manager
(518) 271-3454
Addresses
Street Address
1300 Massachusettes Ave
Troy, NY 12180
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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