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GEROULD'S PROF PHARMACY
DSH330090 ARNOT OGDEN MEDICAL CENTER
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Covered Entity Details
Entity Name
ARNOT OGDEN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330090
Entity Address
600 Roe Ave
ELMIRA, NY 14905
Medicare Provider Number
330090
Participating Start Date
10/27/2012
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
GEROULD'S PROF PHARMACY
Pharmacy Address
GEROULDS PHARMACY
98 W PULTENEY ST
CORNING, NY 14830
Pharmacy Comments
Contract Details
Approval Date
7/11/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jonathan Lawrence, President & CEO
(607) 737-4440
Contract Pharmacy Representative
Geroulds Professional Pharmacy
Mochael Steed, Pharmacy Manager
(607) 936-3233
Signed By Date
7/11/2018
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