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DSH330307B CAYUGA MEDICAL CENTER AT ITHACA (Active)
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Main Details
Name
CAYUGA MEDICAL CENTER AT ITHACA
Subdivision Name
Urgent Care - Cortland
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330307B
Medicare Provider Number
330307
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
5/21/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/22/2019
Last Recertification Date
8/28/2024
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
1129 Commons Ave
Lot 1
Cortland, NY 13045
Billing Address
Cayuga Medical Center at Ithaca
101 Dates Drive
Ithaca, NY 14850
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2016, terminated 7/1/2018. Reinstated 7/1/2019.
05/22/2019
June 2025
June 2025
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