Details | State | Update | | Approved | Active | 1/1/2025 12:01 AM |
Addresses | Billing Address | Insert | Reinstatement | | Cayuga Medical Center at Ithaca
101 Dates Drive
Ithaca, NY 14850 | 12/3/2024 8:10 AM |
Contacts | Authorizing Official | Update | Reinstatement | Collett, John
CHIEF FINANCIAL OFFICER
Cayuga Medical Center at Ithaca
6072744441 | Gould, Rebecca J
President & Chief Financial Officer
Cayuga Medical Center at Ithaca
6077427390 | 12/3/2024 8:10 AM |
Contacts | Signed By | Update | Reinstatement | Collett, John
CHIEF FINANCIAL OFFICER
Cayuga Medical Center at Ithaca
6072744441 | Gould, Rebecca J
President & Chief Financial Officer
Cayuga Medical Center at Ithaca
6077427390 | 12/3/2024 8:10 AM |
Contacts | Primary Contact | Update | Reinstatement | Griswold, Annette
Pharmacy Business Analyst/340B Coordinator
Cayuga Medical Center at Ithaca
6072744218 | Howard, Kimyen
Pharmacy Compliance Supervisor
Schuyler Hospital
6072744211 | 12/3/2024 8:10 AM |
Details | Last Recertification Date | Update | Reinstatement | 8/19/2021 2:24:05 PM | | 12/3/2024 8:10 AM |
Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 12/31/2021 12:00:00 AM | | 12/3/2024 8:10 AM |
Dates | Participating Approval Date | Update | Reinstatement | 5/22/2019 1:02:26 PM | 12/3/2024 8:10:30 AM | 12/3/2024 8:10 AM |
Details | State | Update | Reinstatement | Terminated | Approved | 12/3/2024 8:10 AM |
Dates | Registration Date | Update | Reinstatement | 5/21/2019 3:27:03 PM | 12/2/2024 2:18:06 PM | 12/3/2024 8:10 AM |
Dates | Signed By Date | Update | Reinstatement | 5/21/2019 3:27:06 PM | 12/3/2024 7:37:58 AM | 12/3/2024 8:10 AM |
Dates | Start Date | Update | Reinstatement | 7/1/2019 12:00:00 AM | 1/1/2025 12:00:00 AM | 12/3/2024 8:10 AM |
Terminations | Termination Date | Update | Reinstatement | 1/1/2022 12:00:00 AM | | 12/3/2024 8:10 AM |
Terminations | Termination Effective Date | Update | Reinstatement | 12/31/2021 12:00:00 AM | | 12/3/2024 8:10 AM |
Terminations | Termination Reason | Update | Reinstatement | Never implemented the 340B Program | | 12/3/2024 8:10 AM |
Details | Comments Public | Insert | Reinstatement | | Participated starting 7/1/2019, terminated 1/1/2022. Reinstated 1/1/2025. | 12/3/2024 7:44 AM |
Details | State | Update | | To Be Terminated | Terminated | 1/1/2022 12:01 AM |
Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 12/31/2021 12:00:00 AM | 12/27/2021 10:26 AM |
Details | State | Update | Termination Request | Active | To Be Terminated | 12/27/2021 10:26 AM |
Terminations | Termination Date | Update | Termination Request | | 1/1/2022 12:00:00 AM | 12/27/2021 10:26 AM |
Terminations | Termination Effective Date | Update | Termination Request | | 12/31/2021 12:00:00 AM | 12/27/2021 10:26 AM |
Terminations | Termination Reason | Update | Termination Request | | Never implemented the 340B Program | 12/27/2021 10:26 AM |
Details | Last Recertification Date | Update | Recertification | 9/1/2020 10:10:05 AM | 8/19/2021 2:24:05 PM | 8/19/2021 2:24 PM |
Contacts | Authorizing Official | Update | Profile Change Request | Collett, John
CHIEF FINANCIAL OFFICER
Cayuga Medical Center at Ithaca
6072744441-6073879264 | Collett, John
CHIEF FINANCIAL OFFICER
Cayuga Medical Center at Ithaca
6072744441 | 6/14/2021 11:04 AM |
Contacts | Signed By | Update | Profile Change Request | Collett, John
CHIEF FINANCIAL OFFICER
Cayuga Medical Center at Ithaca
6072744441-6073879264 | Collett, John
CHIEF FINANCIAL OFFICER
Cayuga Medical Center at Ithaca
6072744441 | 6/14/2021 11:04 AM |
Contacts | Authorizing Official | Update | Profile Change Request | Collett, John
CHIEF FINANCIAL OFFICER
Cayuga Medical Center at Ithacq
6072744441 | Collett, John
CHIEF FINANCIAL OFFICER
Cayuga Medical Center at Ithaca
6072744441-6073879264 | 12/27/2020 11:46 AM |
Contacts | Signed By | Update | Profile Change Request | Collett, John
CHIEF FINANCIAL OFFICER
Cayuga Medical Center at Ithacq
6072744441 | Collett, John
CHIEF FINANCIAL OFFICER
Cayuga Medical Center at Ithaca
6072744441-6073879264 | 12/27/2020 11:46 AM |
Medicaid Billing | NPI: Number | Insert | Recertification | | 1962422733 | 9/1/2020 10:10 AM |
Medicaid Billing | NPI: State | Insert | Recertification | | NY | 9/1/2020 10:10 AM |
Medicaid Billing | NPI: Number | Delete | Recertification | 1962422733 ( ) | | 9/1/2020 10:10 AM |
Details | Last Recertification Date | Update | Recertification | 8/26/2019 1:21:05 PM | 9/1/2020 10:10:05 AM | 9/1/2020 10:10 AM |
Details | Last Recertification Date | Update | Recertification | | 8/26/2019 1:21:05 PM | 8/26/2019 1:21 PM |
Details | State | Update | | Approved | Active | 7/1/2019 12:05 AM |
Addresses | Billing Address | Insert | Reinstatement | | Cayuga Medical Center at Ithaca
101 Dates Drive
Ithaca, NY 14850 | 5/22/2019 1:02 PM |
Addresses | Shipping Address | Insert | Reinstatement | | Cayuga Medical Center at Ithaca
101 Dates Drive
3rd Floor
Ithaca, NY 14850 | 5/22/2019 1:02 PM |
Addresses | Shipping Address | Delete | Reinstatement | Cayuga Medical Center at Ithaca
101 Dates Drive
Ithaca, NY 14850 | | 5/22/2019 1:02 PM |
Dates | Participating Approval Date | Update | Reinstatement | | 5/22/2019 1:02:26 PM | 5/22/2019 1:02 PM |
Details | State | Update | Reinstatement | Pending | Approved | 5/22/2019 1:02 PM |
Dates | Signed By Date | Update | Reinstatement | 10/6/2015 12:00:00 AM | 5/21/2019 3:27:06 PM | 5/22/2019 1:02 PM |
Dates | Start Date | Update | Reinstatement | | 7/1/2019 12:00:00 AM | 5/22/2019 1:02 PM |
Details | Comments Public | Insert | Reinstatement | | Participated starting 1/1/2016, terminated 7/1/2018. Reinstated 7/1/2019. | 5/22/2019 12:33 PM |
Details | Last Recertification Date | Update | Reinstatement | 11/6/2017 11:12:59 AM | | 5/21/2019 3:27 PM |
Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 5/31/2018 12:00:00 AM | | 5/21/2019 3:27 PM |
Dates | Participating Approval Date | Update | Reinstatement | 10/26/2015 12:00:00 AM | | 5/21/2019 3:27 PM |
Details | State | Update | Reinstatement | Terminated | Pending | 5/21/2019 3:27 PM |
Dates | Registration Date | Update | Reinstatement | 10/6/2015 12:00:00 AM | 5/21/2019 3:27:03 PM | 5/21/2019 3:27 PM |
Dates | Start Date | Update | Reinstatement | 1/1/2016 12:00:00 AM | | 5/21/2019 3:27 PM |
Terminations | Termination Comments | Update | Reinstatement | New DSH % effective 5/31/18 8.11%. | | 5/21/2019 3:27 PM |
Terminations | Termination Date | Update | Reinstatement | 7/1/2018 12:00:00 AM | | 5/21/2019 3:27 PM |
Terminations | Termination Effective Date | Update | Reinstatement | 5/31/2018 12:00:00 AM | | 5/21/2019 3:27 PM |
Terminations | Termination Reason | Update | Reinstatement | DSH percentage below statutory minimum | | 5/21/2019 3:27 PM |
Details | State | Update | | To Be Terminated | Terminated | 7/1/2018 12:00 AM |
Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 5/31/2018 12:00:00 AM | 6/4/2018 6:28 AM |
Details | State | Update | Termination Request | Active | To Be Terminated | 6/4/2018 6:28 AM |
Terminations | Termination Comments | Update | Termination Request | | New DSH % effective 5/31/18 8.11%. | 6/4/2018 6:28 AM |
Terminations | Termination Date | Update | Termination Request | | 7/1/2018 12:00:00 AM | 6/4/2018 6:28 AM |
Terminations | Termination Effective Date | Update | Termination Request | | 5/31/2018 12:00:00 AM | 6/4/2018 6:28 AM |
Terminations | Termination Reason | Update | Termination Request | | DSH percentage below statutory minimum | 6/4/2018 6:28 AM |
Details | Last Recertification Date | Update | Recertification | 8/11/2016 12:00:00 AM | 11/6/2017 11:12:59 AM | 11/6/2017 11:12 AM |
Contacts | Authorizing Official | Update | | Collett, John
CHIEF FINANCIAL OFFICER
6072744441 | Collett, John
CHIEF FINANCIAL OFFICER
Cayuga Medical Center at Ithacq
6072744441 | 10/11/2017 10:49 AM |
Contacts | Signed By | Update | | Collett, John
CHIEF FINANCIAL OFFICER
6072744441 | Collett, John
CHIEF FINANCIAL OFFICER
Cayuga Medical Center at Ithacq
6072744441 | 10/11/2017 10:49 AM |
Contacts | Primary Contact | Update | | Griswold, Annette
Pharmacy Business Analyst/340B Coordinator
6072744218 | Griswold, Annette
Pharmacy Business Analyst/340B Coordinator
Cayuga Medical Center at Ithaca
6072744218 | 9/19/2017 3:24 PM |
Contacts | Authorizing Official | Insert | | | Collett, John
CHIEF FINANCIAL OFFICER
6072744441 | 8/2/2017 1:51 PM |
Contacts | Signed By | Insert | | | Collett, John
CHIEF FINANCIAL OFFICER
6072744441 | 8/2/2017 1:51 PM |
Addresses | Main Address | Insert | | |
310 Taughannock Blvd
5th Floor
Ithaca, NY 14850 | 8/11/2016 2:41 PM |
Contacts | Primary Contact | Update | | Wilkins, Karen
Cayuga Medical Center at Ithaca
6072744406 | Griswold, Annette
Pharmacy Business Analyst/340B Coordinator
6072744218 | 8/11/2016 2:41 PM |
Details | Last Recertification Date | Update | | | 8/11/2016 12:00:00 AM | 8/11/2016 2:41 PM |
Addresses | Billing Address | Insert | | | Cayuga Medical Center at Ithaca
101 Dates Drive
Ithaca, NY 14850 | 8/1/2016 11:22 AM |
Addresses | Shipping Address | Insert | | | Cayuga Medical Center at Ithaca
101 Dates Drive
Ithaca, NY 14850 | 8/1/2016 11:22 AM |
Contacts | Primary Contact | Insert | | | Wilkins, Karen
Cayuga Medical Center at Ithaca
6072744406 | 1/5/2016 11:28 AM |
Dates | Participating Approval Date | Update | | | 10/26/2015 12:00:00 AM | 10/26/2015 3:48 PM |
Details | State | Update | | Pending | Active | 10/26/2015 3:48 PM |
Dates | Start Date | Update | | | 1/1/2016 12:00:00 AM | 10/26/2015 3:48 PM |
Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_54578 | DSH330307F | 10/7/2015 1:59 PM |
Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_54578 | 10/6/2015 2:26 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 10/6/2015 2:26 PM |
Medicaid Billing | Medicaid: Number | Insert | | | 03001085 | 10/6/2015 2:26 PM |
Medicaid Billing | Medicaid: State | Insert | | | NY | 10/6/2015 2:26 PM |
Medicaid Billing | NPI: Number | Insert | | | 1962422733 | 10/6/2015 2:26 PM |
Details | Last Recertification Date | Insert | | | | 10/6/2015 2:26 PM |
Details | Grant Number | Insert | | | | 10/6/2015 2:26 PM |
Details | 340B ID | Insert | | | | 10/6/2015 2:26 PM |
Details | Is Authorizing Official EHB Data | Insert | | | | 10/6/2015 2:26 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/6/2015 2:26 PM |
Details | Medicare Provider Number | Insert | | | 330307 | 10/6/2015 2:26 PM |
Details | Entity Name | Insert | | | CAYUGA MEDICAL CENTER AT ITHACA | 10/6/2015 2:26 PM |
Details | Program Code | Insert | | | DSH | 10/6/2015 2:26 PM |
Details | Entity Subname | Insert | | | Sports Medicine | 10/6/2015 2:26 PM |
Dates | Participating Approval Date | Insert | | | | 10/6/2015 2:26 PM |
Details | State | Insert | | | Pending | 10/6/2015 2:26 PM |
Dates | Registration Date | Insert | | | 10/6/2015 12:00:00 AM | 10/6/2015 2:26 PM |
Dates | Signed By Date | Insert | | | 10/6/2015 12:00:00 AM | 10/6/2015 2:26 PM |
Dates | Start Date | Insert | | | | 10/6/2015 2:26 PM |
Terminations | Termination Comments | Insert | | | | 10/6/2015 2:26 PM |
Terminations | Termination Date | Insert | | | | 10/6/2015 2:26 PM |
Terminations | Termination Effective Date | Insert | | | | 10/6/2015 2:26 PM |
Terminations | Termination Reason | Insert | | | | 10/6/2015 2:26 PM |