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DSH330307C CAYUGA MEDICAL CENTER AT ITHACA (Active)
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Main Details
Name
CAYUGA MEDICAL CENTER AT ITHACA
Subdivision Name
CHOA Main Oncology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330307C
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
401 Cayuga Park Lane
Suite 300
Ithaca, NY 14850
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
May 2025
May 2025
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