340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
SCH230133-06 MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL (Terminated)
Print
Main Details
Name
MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Subdivision Name
OMH Medical Group - Elmira
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH230133-06
Medicare Provider Number
230133
Outpatient Facility Provider Number
238662
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/16/2015
Last Recertification Date
9/9/2019
Termination Date
Termination Reason
10/1/2020
Site closure
Contacts
Authorizing Official
Munson Healthcare Otsego Memorial Hospital
Thomas R Lemon, President & CEO
(989) 731-2215
Primary Contact
Otsego Memorial Hospital
KAY HANNA DELUCA, DIRECTOR, PHARMACY
(989) 731-2138
Addresses
Street Address
2572 N US HIGHWAY 131
OMH MEDICAL GROUP BOYNE VALLEY
ELMIRA, MI 49730-8252
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
May 2025
May 2025
week
S
M
T
W
T
F
S
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
20
11
12
13
14
15
16
17
21
18
19
20
21
22
23
24
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session