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DSH330241CE UNIVERSITY HOSPITAL (Active)
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Main Details
Name
UNIVERSITY HOSPITAL
Subdivision Name
Pediatric Specialty Clinic - Pediatric Pulmonary, CF and adult CF
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330241CE
Medicare Provider Number
330241
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/1/2020
Participating Start Date
4/22/2020
Participating Approval Date
4/10/2020
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
SUNY Upstate Medical University Hospital
Stuart M. Wright, Chief Financial Officer
(315) 464-5179
Primary Contact
SUNY Upstate Medical University Hospital
Amanda Marzella, 340B Contract Pharmacy Manager
(315) 464-6039
Addresses
Street Address
475 Irving Avenue
Suite 090
Syracuse, NY 13210
Billing Address
Upstate University Hospital
750 East Adams Street
Syracuse, NY 13210
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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