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SCH330307-00 CAYUGA MEDICAL CENTER AT ITHACA (Terminated)
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Main Details
Name
CAYUGA MEDICAL CENTER AT ITHACA
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH330307-00
Medicare Provider Number
330307
Additional Details
Current Program Status
Terminated
Registration Date
7/2/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/1/2018
Last Recertification Date
Termination Date
Termination Reason
7/1/2019
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
101 DATES DRIVE
ITHACA, NY 14850
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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