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DSH330307G CAYUGA MEDICAL CENTER AT ITHACA (Terminated)
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Main Details
Name
CAYUGA MEDICAL CENTER AT ITHACA
Subdivision Name
Imaging - Cortland - MRI
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330307G
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
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
May 2025
May 2025
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