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DSH330136BC MARY IMOGENE BASSETT HOSPITAL (Terminated)
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Main Details
Name
MARY IMOGENE BASSETT HOSPITAL
Subdivision Name
HARTWICK SEMINARY SPECIALTY SERVICE - HARTWICK SEMINARY SPEC SVCS
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330136BC
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
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
4580 STATE HIGHWAY 28
MILFORD, NY 13807-1147
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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