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CAH331321-00 ALICE HYDE MEDICAL CENTER (Active)
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Main Details
Name
ALICE HYDE MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH331321-00
Medicare Provider Number
331321
Additional Details
Current Program Status
Active
Registration Date
11/21/2023
Participating Start Date
11/27/2023
Participating Approval Date
11/27/2023
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Alice Hyde Medical Center/Champlain Valley Physicians Hospital
Matej Kollar, Vice President/Chief Financial Officer
(518) 481-8065
Primary Contact
Alice Hyde Medical Center
Michael Sprague Dufort, Director of Pharmacy
(518) 481-2404
Addresses
Street Address
133 PARK STREET
MALONE, NY 12953
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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