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DSH330047AP ST. MARYS HEALTHCARE (Terminated)
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Main Details
Name
ST. MARYS HEALTHCARE
Subdivision Name
Johnstown OB/GYN - OB\GYN
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330047AP
Medicare Provider Number
330047
Outpatient Facility Provider Number
330047
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/8/2019
Last Recertification Date
Termination Date
Termination Reason
7/1/2020
Site closure
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
700 South Perry Street
Johnstown, NY 12095
Billing Address
St. Mary's Healthcare
427 Guy Park Avenue
Amsterdam, NY 12010
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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