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DSH330197AZ CANTON-POTSDAM HOSPITAL (Active)
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Main Details
Name
CANTON-POTSDAM HOSPITAL
Subdivision Name
NEUROLOGY - NEUROLOGY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330197AZ
Medicare Provider Number
330197
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/11/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/24/2019
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Rochester Regional Health
Shawn Bishop, Vice President, RRH Revenue & Reimbursement
(585) 922-0056
Primary Contact
RRH
Robert Michael Scardino, 340B Pharmacy System Manager
(585) 319-6750
Addresses
Street Address
6119 US HIGHWAY 11
CANTON, NY 13617
Billing Address
CANTON-POTSDAM HOSPITAL
50 LEROY STREET
POTSDAM, NY 13676
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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