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DSH330307R CAYUGA MEDICAL CENTER AT ITHACA (Active)
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Main Details
Name
CAYUGA MEDICAL CENTER AT ITHACA
Subdivision Name
Cayuga Urology - Urology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330307R
Medicare Provider Number
330307
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/9/2025
Participating Start Date
4/1/2025
Participating Approval Date
1/29/2025
Last Recertification Date
Contacts
Authorizing Official
Cayuga Medical Center at Ithaca
Rebecca J Gould, President & Chief Financial Officer
(607) 742-7390
Primary Contact
Schuyler Hospital
Kimyen Howard, Pharmacy Compliance Supervisor
(607) 274-4211
Addresses
Street Address
201 Dates Dr
Suite 102
ITHACA, NY 14850
Billing Address
Cayuga Medical Center at Ithaca - Ithaca, NY
101 Dates Dr
3RD FLOOR
Ithaca, NY 14850
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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