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DSH330090Q ARNOT OGDEN MEDICAL CENTER (Terminated)
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Main Details
Name
ARNOT OGDEN MEDICAL CENTER
Subdivision Name
Arnot Ogden Medical Center - Arnot Health Wound Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330090Q
Medicare Provider Number
330090
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/3/2019
Participating Start Date
10/1/2019
Participating Approval Date
8/5/2019
Last Recertification Date
9/5/2020
Termination Date
Termination Reason
10/1/2020
Other
Contacts
Authorizing Official
Arnot Health
Mark Dworsky, Vice President of Clinical Services
(607) 737-4152
Primary Contact
Arnot Health
Bill Bacon, Director of Pharmacy
(607) 737-4311
Addresses
Street Address
602 Ivy St
Elmira, NY 14905
Billing Address
Arnot Ogden Medical Center
600 Roe Ave
Elmira, NY 14905
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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