340B Drug Pricing Program Database
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DSH330203G CROUSE HOSPITAL (Active)
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Main Details
Name
CROUSE HOSPITAL
Subdivision Name
CNY Medical Center- Cardiology Suite 550 - Cardiology Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330203G
Medicare Provider Number
330203
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
9/8/2023
Participating Start Date
10/1/2023
Participating Approval Date
9/13/2023
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Crouse Hospital
Kevin Randall, Chief Financial Officer
(315) 470-7589
Primary Contact
Crouse Health
Dwayne Cleveland, Manager of 340B
(315) 470-3402
Addresses
Street Address
739 Irving Avenue
550
Syracuse, NY 13210
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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