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RRC330140-15 ST. JOSEPHS HOSPITAL HEALTH CENTER (Terminated)
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Main Details
Name
ST. JOSEPHS HOSPITAL HEALTH CENTER
Subdivision Name
MCHC/OB - OB Clinic
Type
Rural Referral Center
Rural
Yes
340B ID
RRC330140-15
Medicare Provider Number
330140
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2021
Participating Start Date
10/1/2021
Participating Approval Date
9/1/2021
Last Recertification Date
9/8/2023
Termination Date
Termination Reason
7/1/2024
Site closure
Contacts
Authorizing Official
St. Joseph's Hospital Health Center
Meredith Anne Price, Chief Financial Officer
(315) 448-5888
Primary Contact
St. Joseph's Hospital Health Center
Bernie E Delello, Director Pharmacy
(315) 448-5199
Addresses
Street Address
321 Gifford St
Suite 101, 103 Primary Care Center West/OB-GYN Ser
Syracuse, NY 13204-3201
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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