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DSH330047AN ST. MARYS HEALTHCARE (Terminated)
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Main Details
Name
ST. MARYS HEALTHCARE
Subdivision Name
CANAJOHARIE HEALTH CENTER - Pediatric Pulmonology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330047AN
Medicare Provider Number
330047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/1/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/3/2019
Last Recertification Date
8/24/2020
Termination Date
Termination Reason
4/1/2021
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
St. Mary's Healthcare
Rick Henze, Vice President of Finance/CFO
(518) 841-7435
Primary Contact
St. Mary's Healthcare
Keith Waters, Sr. Director of Finance
(518) 770-7583
Addresses
Street Address
48 ERIE BLVD
CANAJOHARIE, NY 13317-1133
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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