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DSH330188R Mount St. Mary's Hospital and Health Center (Terminated)
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Main Details
Name
Mount St. Mary's Hospital and Health Center
Subdivision Name
MSM HEALTH CENTER LOCKPORT - HEALTH CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330188R
Medicare Provider Number
330188
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/11/2019
Participating Start Date
10/1/2019
Participating Approval Date
8/13/2019
Last Recertification Date
8/29/2023
Termination Date
Termination Reason
4/1/2024
Site closure
Contacts
Authorizing Official
Catholic Health System
Michael Osborne, Vice President, Finance
(716) 828-2011
Primary Contact
Catholic Health System
Tristan Diane Greer, 340B Program Business Manager
(716) 923-2920
Addresses
Street Address
6000 BROCKTON DR
STE 106
LOCKPORT, NY 14094-9273
Billing Address
Mount St. Mary's Hospital and Health Center c/o Catholic Health
144 Genesee Street
4th Floor
Buffalo, NY 14203
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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