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GEROULD'S PROFESSIONAL
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 PROFESSIONAL
Pharmacy Address
PHARMACY INC
2887 WESTINGHOUSE RD
HORSEHEADS, NY 14845
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
Barbara MacBlane, Pharmacy Manager
(607) 796-2193
Signed By Date
7/11/2018
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