340B Drug Pricing Program Database
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DSH330047AS ST. MARYS HEALTHCARE (Active)
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Main Details
Name
ST. MARYS HEALTHCARE
Subdivision Name
Neuro Clinic - Headache Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330047AS
Medicare Provider Number
330047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/3/2023
Participating Start Date
4/1/2023
Participating Approval Date
2/16/2023
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
St. Mary's Healthcare
Keith Waters, Vice President of Finance/CFO
(518) 770-7583
Primary Contact
St. Mary's Healthcare
Tami Wessel, 340B Program Lead
(518) 256-1163
Addresses
Street Address
4950 State Highway 30
Amsterdam, NY 12010
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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