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DSH330307J CAYUGA MEDICAL CENTER AT ITHACA (Terminated)
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Main Details
Name
CAYUGA MEDICAL CENTER AT ITHACA
Subdivision Name
Imaging - East - MRI
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330307J
Medicare Provider Number
330307
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/21/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/22/2019
Last Recertification Date
Termination Date
Termination Reason
10/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
Cayuga Medical Center at Ithaca
John Collett, CHIEF FINANCIAL OFFICER
(607) 274-4441
Primary Contact
Cayuga Medical Center at Ithaca
Annette Griswold, Pharmacy Business Analyst/340B Coordinator
(607) 274-4218
Addresses
Street Address
10 Arrowwood Drive
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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