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DSH330136 MARY IMOGENE BASSETT HOSPITAL (Terminated)
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Main Details
Name
MARY IMOGENE BASSETT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330136
Medicare Provider Number
330136
Additional Details
Current Program Status
Terminated
Registration Date
10/5/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/8/2021
Last Recertification Date
9/3/2023
Termination Date
Termination Reason
7/1/2024
Change of covered entity type
Contacts
Authorizing Official
Bassett Healthcare Network
James Vielkind, Vice President Finance
(315) 823-5281
Primary Contact
Bassett Healthcare - Cooperstown, NY
Kim Metcalf, Chief Pharmacy Officer
(860) 975-5636
Addresses
Street Address
1 ATWELL ROAD
COOPERSTOWN, NY 13326
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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