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DSH330241CM UNIVERSITY HOSPITAL (Terminated)
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Main Details
Name
UNIVERSITY HOSPITAL
Subdivision Name
Influenza-Like Illness Clinic - Adult and Pediatric Seasonal Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330241CM
Medicare Provider Number
330241
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/1/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/4/2021
Last Recertification Date
8/29/2022
Termination Date
Termination Reason
7/1/2023
Site closure
Contacts
Authorizing Official
SUNY Upstate Medical University Hospital
Stuart M. Wright, Chief Financial Officer
(315) 464-5179
Primary Contact
SUNY Upstate Medical University Hospital
Katie Schmidt, 340B Coordinator
(315) 464-4212
Addresses
Street Address
4900 Broad Road
POB South
Suite 1K
Syracuse, NY 13215
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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