340B Drug Pricing Program Database


DSH330307F CAYUGA MEDICAL CENTER AT ITHACA (Active) - information as of 5/1/2025 11:52:14 PM

Main Details
CAYUGA MEDICAL CENTER AT ITHACA
Sports Medicine
Disproportionate Share Hospital
Yes
DSH330307F
330307


Additional Details
Active
12/2/2024
1/1/2025
12/3/2024

Contacts

Cayuga Medical Center at Ithaca
Rebecca J Gould, President & Chief Financial Officer
(607) 742-7390

Schuyler Hospital
Kimyen Howard, Pharmacy Compliance Supervisor
(607) 274-4211

Addresses

310 Taughannock Blvd
5th Floor
Ithaca, NY 14850

Cayuga Medical Center at Ithaca
101 Dates Drive
Ithaca, NY 14850


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
Participated starting 7/1/2019, terminated 1/1/2022. Reinstated 1/1/2025.12/03/2024
Participated starting 1/1/2016, terminated 7/1/2018. Reinstated 7/1/2019.05/22/2019
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
NY030010851962422733
Shipping Addresses

Cayuga Medical Center at Ithaca
101 Dates Drive
3rd Floor
Ithaca, NY 14850
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH330307AChildDSHCAYUGA MEDICAL CENTER AT ITHACAUrgent Care East Campus10 Arrowwood DriveIthacaNYTerminated
DSH330307BChildDSHCAYUGA MEDICAL CENTER AT ITHACAUrgent Care - Cortland1129 Commons AveCortlandNYActive
DSH330307CChildDSHCAYUGA MEDICAL CENTER AT ITHACACHOA Main Oncology401 Cayuga Park LaneIthacaNYActive
DSH330307DChildDSHCAYUGA MEDICAL CENTER AT ITHACACHOA East Campus Oncology10 Arrowwood DriveIthacaNYActive
DSH330307EChildDSHCAYUGA MEDICAL CENTER AT ITHACASurgicare10 Arrowwood DriveIthacaNYActive
DSH330307FChildDSHCAYUGA MEDICAL CENTER AT ITHACASports Medicine310 Taughannock BlvdIthacaNYActive
DSH330307GChildDSHCAYUGA MEDICAL CENTER AT ITHACAImaging - Cortland - MRI1129 Commons Ave.CortlandNYTerminated
DSH330307HChildDSHCAYUGA MEDICAL CENTER AT ITHACAImaging- Cortland - CT1129 Commons Ave.CortlandNYTerminated
DSH330307JChildDSHCAYUGA MEDICAL CENTER AT ITHACAImaging - East - MRI10 Arrowwood DriveIthacaNYTerminated
DSH330307KChildDSHCAYUGA MEDICAL CENTER AT ITHACAImaging-East-Cat Scan10 Arrowwood DriveIthacaNYTerminated
DSH330307LChildDSHCAYUGA MEDICAL CENTER AT ITHACAInfusion - Cortland Infusion - Infusion1129 Commons Ave.CortlandNYActive
DSH330307MChildDSHCAYUGA MEDICAL CENTER AT ITHACAEndoscopy - East - Gastro Intestinal Services2435 North Triphammer RoadIthacaNYActive
DSH330307NChildDSHCAYUGA MEDICAL CENTER AT ITHACACHOA Cortland Campus Oncology - Oncology1081 Commons AveCortlandNYActive
DSH330307PChildDSHCAYUGA MEDICAL CENTER AT ITHACAPain Clinic - East - Pain Clinic10 Arrowwood Dr.IthacaNYActive
DSH330307QChildDSHCAYUGA MEDICAL CENTER AT ITHACACAYUGA CENTER FOR HEALTHLY LIVING - CCHL310 TAUGHANNOCK BLVDITHACANYActive
DSH330307RChildDSHCAYUGA MEDICAL CENTER AT ITHACACayuga Urology - Urology201 Dates DrITHACANYActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsStateUpdate ApprovedActive1/1/2025 12:01 AM
AddressesBilling AddressInsertReinstatement Cayuga Medical Center at Ithaca 101 Dates Drive Ithaca, NY 1485012/3/2024 8:10 AM
ContactsAuthorizing OfficialUpdateReinstatementCollett, John CHIEF FINANCIAL OFFICER Cayuga Medical Center at Ithaca 6072744441Gould, Rebecca J President & Chief Financial Officer Cayuga Medical Center at Ithaca 607742739012/3/2024 8:10 AM
ContactsSigned ByUpdateReinstatementCollett, John CHIEF FINANCIAL OFFICER Cayuga Medical Center at Ithaca 6072744441Gould, Rebecca J President & Chief Financial Officer Cayuga Medical Center at Ithaca 607742739012/3/2024 8:10 AM
ContactsPrimary ContactUpdateReinstatementGriswold, Annette Pharmacy Business Analyst/340B Coordinator Cayuga Medical Center at Ithaca 6072744218Howard, Kimyen Pharmacy Compliance Supervisor Schuyler Hospital 607274421112/3/2024 8:10 AM
DetailsLast Recertification DateUpdateReinstatement8/19/2021 2:24:05 PM 12/3/2024 8:10 AM
DatesLast Date That 340B Drugs PurchasedUpdateReinstatement12/31/2021 12:00:00 AM 12/3/2024 8:10 AM
DatesParticipating Approval DateUpdateReinstatement5/22/2019 1:02:26 PM12/3/2024 8:10:30 AM12/3/2024 8:10 AM
DetailsStateUpdateReinstatementTerminatedApproved12/3/2024 8:10 AM
DatesRegistration DateUpdateReinstatement5/21/2019 3:27:03 PM12/2/2024 2:18:06 PM12/3/2024 8:10 AM
DatesSigned By DateUpdateReinstatement5/21/2019 3:27:06 PM12/3/2024 7:37:58 AM12/3/2024 8:10 AM
DatesStart DateUpdateReinstatement7/1/2019 12:00:00 AM1/1/2025 12:00:00 AM12/3/2024 8:10 AM
TerminationsTermination DateUpdateReinstatement1/1/2022 12:00:00 AM 12/3/2024 8:10 AM
TerminationsTermination Effective DateUpdateReinstatement12/31/2021 12:00:00 AM 12/3/2024 8:10 AM
TerminationsTermination ReasonUpdateReinstatementNever implemented the 340B Program 12/3/2024 8:10 AM
DetailsComments PublicInsertReinstatement Participated starting 7/1/2019, terminated 1/1/2022. Reinstated 1/1/2025.12/3/2024 7:44 AM
DetailsStateUpdate To Be TerminatedTerminated1/1/2022 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 12/31/2021 12:00:00 AM12/27/2021 10:26 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated12/27/2021 10:26 AM
TerminationsTermination DateUpdateTermination Request 1/1/2022 12:00:00 AM12/27/2021 10:26 AM
TerminationsTermination Effective DateUpdateTermination Request 12/31/2021 12:00:00 AM12/27/2021 10:26 AM
TerminationsTermination ReasonUpdateTermination Request Never implemented the 340B Program12/27/2021 10:26 AM
DetailsLast Recertification DateUpdateRecertification9/1/2020 10:10:05 AM8/19/2021 2:24:05 PM8/19/2021 2:24 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestCollett, John CHIEF FINANCIAL OFFICER Cayuga Medical Center at Ithaca 6072744441-6073879264Collett, John CHIEF FINANCIAL OFFICER Cayuga Medical Center at Ithaca 60727444416/14/2021 11:04 AM
ContactsSigned ByUpdateProfile Change RequestCollett, John CHIEF FINANCIAL OFFICER Cayuga Medical Center at Ithaca 6072744441-6073879264Collett, John CHIEF FINANCIAL OFFICER Cayuga Medical Center at Ithaca 60727444416/14/2021 11:04 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestCollett, John CHIEF FINANCIAL OFFICER Cayuga Medical Center at Ithacq 6072744441Collett, John CHIEF FINANCIAL OFFICER Cayuga Medical Center at Ithaca 6072744441-607387926412/27/2020 11:46 AM
ContactsSigned ByUpdateProfile Change RequestCollett, John CHIEF FINANCIAL OFFICER Cayuga Medical Center at Ithacq 6072744441Collett, John CHIEF FINANCIAL OFFICER Cayuga Medical Center at Ithaca 6072744441-607387926412/27/2020 11:46 AM
Medicaid BillingNPI: NumberInsertRecertification 19624227339/1/2020 10:10 AM
Medicaid BillingNPI: StateInsertRecertification NY9/1/2020 10:10 AM
Medicaid BillingNPI: NumberDeleteRecertification1962422733 ( ) 9/1/2020 10:10 AM
DetailsLast Recertification DateUpdateRecertification8/26/2019 1:21:05 PM9/1/2020 10:10:05 AM9/1/2020 10:10 AM
DetailsLast Recertification DateUpdateRecertification 8/26/2019 1:21:05 PM8/26/2019 1:21 PM
DetailsStateUpdate ApprovedActive7/1/2019 12:05 AM
AddressesBilling AddressInsertReinstatement Cayuga Medical Center at Ithaca 101 Dates Drive Ithaca, NY 148505/22/2019 1:02 PM
AddressesShipping AddressInsertReinstatement Cayuga Medical Center at Ithaca 101 Dates Drive 3rd Floor Ithaca, NY 148505/22/2019 1:02 PM
AddressesShipping AddressDeleteReinstatementCayuga Medical Center at Ithaca 101 Dates Drive Ithaca, NY 14850 5/22/2019 1:02 PM
DatesParticipating Approval DateUpdateReinstatement 5/22/2019 1:02:26 PM5/22/2019 1:02 PM
DetailsStateUpdateReinstatementPendingApproved5/22/2019 1:02 PM
DatesSigned By DateUpdateReinstatement10/6/2015 12:00:00 AM5/21/2019 3:27:06 PM5/22/2019 1:02 PM
DatesStart DateUpdateReinstatement 7/1/2019 12:00:00 AM5/22/2019 1:02 PM
DetailsComments PublicInsertReinstatement Participated starting 1/1/2016, terminated 7/1/2018. Reinstated 7/1/2019.5/22/2019 12:33 PM
DetailsLast Recertification DateUpdateReinstatement11/6/2017 11:12:59 AM 5/21/2019 3:27 PM
DatesLast Date That 340B Drugs PurchasedUpdateReinstatement5/31/2018 12:00:00 AM 5/21/2019 3:27 PM
DatesParticipating Approval DateUpdateReinstatement10/26/2015 12:00:00 AM 5/21/2019 3:27 PM
DetailsStateUpdateReinstatementTerminatedPending5/21/2019 3:27 PM
DatesRegistration DateUpdateReinstatement10/6/2015 12:00:00 AM5/21/2019 3:27:03 PM5/21/2019 3:27 PM
DatesStart DateUpdateReinstatement1/1/2016 12:00:00 AM 5/21/2019 3:27 PM
TerminationsTermination CommentsUpdateReinstatementNew DSH % effective 5/31/18 8.11%. 5/21/2019 3:27 PM
TerminationsTermination DateUpdateReinstatement7/1/2018 12:00:00 AM 5/21/2019 3:27 PM
TerminationsTermination Effective DateUpdateReinstatement5/31/2018 12:00:00 AM 5/21/2019 3:27 PM
TerminationsTermination ReasonUpdateReinstatementDSH percentage below statutory minimum 5/21/2019 3:27 PM
DetailsStateUpdate To Be TerminatedTerminated7/1/2018 12:00 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 5/31/2018 12:00:00 AM6/4/2018 6:28 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated6/4/2018 6:28 AM
TerminationsTermination CommentsUpdateTermination Request New DSH % effective 5/31/18 8.11%.6/4/2018 6:28 AM
TerminationsTermination DateUpdateTermination Request 7/1/2018 12:00:00 AM6/4/2018 6:28 AM
TerminationsTermination Effective DateUpdateTermination Request 5/31/2018 12:00:00 AM6/4/2018 6:28 AM
TerminationsTermination ReasonUpdateTermination Request DSH percentage below statutory minimum6/4/2018 6:28 AM
DetailsLast Recertification DateUpdateRecertification8/11/2016 12:00:00 AM11/6/2017 11:12:59 AM11/6/2017 11:12 AM
ContactsAuthorizing OfficialUpdate Collett, John CHIEF FINANCIAL OFFICER 6072744441Collett, John CHIEF FINANCIAL OFFICER Cayuga Medical Center at Ithacq 607274444110/11/2017 10:49 AM
ContactsSigned ByUpdate Collett, John CHIEF FINANCIAL OFFICER 6072744441Collett, John CHIEF FINANCIAL OFFICER Cayuga Medical Center at Ithacq 607274444110/11/2017 10:49 AM
ContactsPrimary ContactUpdate Griswold, Annette Pharmacy Business Analyst/340B Coordinator 6072744218Griswold, Annette Pharmacy Business Analyst/340B Coordinator Cayuga Medical Center at Ithaca 60727442189/19/2017 3:24 PM
ContactsAuthorizing OfficialInsert  Collett, John CHIEF FINANCIAL OFFICER 60727444418/2/2017 1:51 PM
ContactsSigned ByInsert  Collett, John CHIEF FINANCIAL OFFICER 60727444418/2/2017 1:51 PM
AddressesMain AddressInsert   310 Taughannock Blvd 5th Floor Ithaca, NY 148508/11/2016 2:41 PM
ContactsPrimary ContactUpdate Wilkins, Karen Cayuga Medical Center at Ithaca 6072744406Griswold, Annette Pharmacy Business Analyst/340B Coordinator 60727442188/11/2016 2:41 PM
DetailsLast Recertification DateUpdate  8/11/2016 12:00:00 AM8/11/2016 2:41 PM
AddressesBilling AddressInsert  Cayuga Medical Center at Ithaca 101 Dates Drive Ithaca, NY 148508/1/2016 11:22 AM
AddressesShipping AddressInsert  Cayuga Medical Center at Ithaca 101 Dates Drive Ithaca, NY 148508/1/2016 11:22 AM
ContactsPrimary ContactInsert  Wilkins, Karen Cayuga Medical Center at Ithaca 60727444061/5/2016 11:28 AM
DatesParticipating Approval DateUpdate  10/26/2015 12:00:00 AM10/26/2015 3:48 PM
DetailsStateUpdate PendingActive10/26/2015 3:48 PM
DatesStart DateUpdate  1/1/2016 12:00:00 AM10/26/2015 3:48 PM
Details340B IDUpdate OUTPATIENT_ONLINE_REG_54578DSH330307F10/7/2015 1:59 PM
Details340B IDUpdate  OUTPATIENT_ONLINE_REG_5457810/6/2015 2:26 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False10/6/2015 2:26 PM
Medicaid BillingMedicaid: NumberInsert  0300108510/6/2015 2:26 PM
Medicaid BillingMedicaid: StateInsert  NY10/6/2015 2:26 PM
Medicaid BillingNPI: NumberInsert  196242273310/6/2015 2:26 PM
DetailsLast Recertification DateInsert   10/6/2015 2:26 PM
DetailsGrant NumberInsert   10/6/2015 2:26 PM
Details340B IDInsert   10/6/2015 2:26 PM
DetailsIs Authorizing Official EHB DataInsert   10/6/2015 2:26 PM
DatesLast Date That 340B Drugs PurchasedInsert   10/6/2015 2:26 PM
DetailsMedicare Provider NumberInsert  33030710/6/2015 2:26 PM
DetailsEntity NameInsert  CAYUGA MEDICAL CENTER AT ITHACA10/6/2015 2:26 PM
DetailsProgram CodeInsert  DSH10/6/2015 2:26 PM
DetailsEntity SubnameInsert  Sports Medicine10/6/2015 2:26 PM
DatesParticipating Approval DateInsert   10/6/2015 2:26 PM
DetailsStateInsert  Pending10/6/2015 2:26 PM
DatesRegistration DateInsert  10/6/2015 12:00:00 AM10/6/2015 2:26 PM
DatesSigned By DateInsert  10/6/2015 12:00:00 AM10/6/2015 2:26 PM
DatesStart DateInsert   10/6/2015 2:26 PM
TerminationsTermination CommentsInsert   10/6/2015 2:26 PM
TerminationsTermination DateInsert   10/6/2015 2:26 PM
TerminationsTermination Effective DateInsert   10/6/2015 2:26 PM
TerminationsTermination ReasonInsert   10/6/2015 2:26 PM