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DSH330307M CAYUGA MEDICAL CENTER AT ITHACA (Active)
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Main Details
Name
CAYUGA MEDICAL CENTER AT ITHACA
Subdivision Name
Endoscopy - East - Gastro Intestinal Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330307M
Medicare Provider Number
330307
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/13/2022
Participating Start Date
10/1/2022
Participating Approval Date
7/28/2022
Last Recertification Date
8/28/2024
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
2435 North Triphammer Road
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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