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DSH330307F CAYUGA MEDICAL CENTER AT ITHACA (Active)
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Main Details
Name
CAYUGA MEDICAL CENTER AT ITHACA
Subdivision Name
Sports Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330307F
Medicare Provider Number
330307
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
12/2/2024
Participating Start Date
1/1/2025
Participating Approval Date
12/3/2024
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
310 Taughannock Blvd
5th Floor
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 7/1/2019, terminated 1/1/2022. Reinstated 1/1/2025.
12/03/2024
Participated starting 1/1/2016, terminated 7/1/2018. Reinstated 7/1/2019.
05/22/2019
May 2025
May 2025
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