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DSH330197AX CANTON-POTSDAM HOSPITAL (Terminated)
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Main Details
Name
CANTON-POTSDAM HOSPITAL
Subdivision Name
CPH PULMONOLOGY - PULMONOLOGY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330197AX
Medicare Provider Number
330197
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/4/2021
Participating Start Date
10/6/2021
Participating Approval Date
10/6/2021
Last Recertification Date
8/30/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
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
77 WEST BARNEY STREET
GOUVERNEUR, NY 13642
Billing Address
CANTON-POTSDAM HOSPITAL
50 LEROY STREET
POTSDAM, NY 13676
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (1/1/2020) until terminated effective date: (10/01/21), reinstatement effective date: (10/06/21)
10/06/2021
April 2025
April 2025
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