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DSH330090A ARNOT OGDEN MEDICAL CENTER (Terminated)
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Main Details
Name
ARNOT OGDEN MEDICAL CENTER
Subdivision Name
IVY II DIALYSIS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330090A
Medicare Provider Number
330090
Outpatient Facility Provider Number
333559
Additional Details
Current Program Status
Terminated
Registration Date
3/4/2011
Participating Start Date
10/27/2012
Participating Approval Date
11/29/2012
Last Recertification Date
9/1/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Arnot Health
Mark Dworsky, Vice President of Clinical Services
(607) 737-4152
Primary Contact
Arnot Helath
BILL BACON, DIRECTOR OF PHARMACY
(607) 737-4311
Addresses
Street Address
602 IVY STREET
ELMIRA, NY 14905
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/20/12 participating 4/1/11 thru 6/30/12, not participating 7/1/12 thru 10/26/12, reinstated based on new registration, early start date due to post-Sandy public health emergency determination for the State of New York; 6/28/12 Terminated at the request of the covered entity, effective 7/1/12
11/29/2012
11/20/12 participating 4/1/11 thru 6/30/12, not participating 7/1/12 thru 10/26/12, reinstated based on new registration submitted (); 6/28/12 Terminated at the request of the covered entity, effective 7/1/12
11/29/2012
11/20/12 participating 4/1/11 thru 6/30/12, not participating 7/1/12 thru 11/20/12; 6/28/12 Terminated at the request of the covered entity, effective 7/1/12
11/20/2012
6/28/12 Terminated at the request of the covered entity, effective 7/1/12
06/28/2012
April 2025
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