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DSH330136AU MARY IMOGENE BASSETT HOSPITAL (Terminated)
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Main Details
Name
MARY IMOGENE BASSETT HOSPITAL
Subdivision Name
BASSETT HEALTHCARE MORRIS - Bassett Healthcare Morris Health Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330136AU
Medicare Provider Number
330136
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/7/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/21/2021
Last Recertification Date
8/24/2023
Termination Date
Termination Reason
4/1/2024
Site closure
Contacts
Authorizing Official
Bassett Healthcare Network
James Vielkind, Vice President Finance
(315) 823-5281
Primary Contact
Bassett Healthcare Network
Russell McCall, 340B Coordinator
(607) 547-3347
Addresses
Street Address
93 MAIN ST
MORRIS, NY 13808-6919
Billing Address
MARY IMOGENE BASSETT HOSPITAL
ONE ATWELL ROAD
COOPERSTOWN, NY 13326
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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