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O'CONNOR HOSPITAL
SCH330136-00 MARY IMOGENE BASSETT HOSPITAL
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Covered Entity Details
Entity Name
MARY IMOGENE BASSETT HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH330136-00
Entity Address
1 ATWELL ROAD
COOPERSTOWN, NY 13326
Medicare Provider Number
330136
Participating Start Date
7/1/2024
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
O'CONNOR HOSPITAL
Pharmacy Address
O'CONNOR HOSPITAL
460 ANDES RD
DELHI, NY 13753
Pharmacy Comments
Contract Details
Approval Date
10/8/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
William LeCates, MD, President CEO BMC
(607) 547-7600
Contract Pharmacy Representative
O'Connor Hospital
Erin Kingsbury, Pharmacy Manager
(607) 746-0458
Signed By Date
10/8/2018
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