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31ST & 3RD PHARMACY INC
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
31ST & 3RD PHARMACY INC
Pharmacy Address
D/B/A AVITA PHARMACY 1063
1860 WALT WHITMAN RD STE 700
MELVILLE, NY 11747
Pharmacy Comments
Contract Details
Approval Date
1/4/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
4/1/2019
Contract Comments
Contacts
Covered Entity Signing Official
Jonathan Lawrence, President & CEO
(607) 737-4440
Contract Pharmacy Representative
Paramount Pharmacy
John F. Civitello, 340B Program Director
(631) 815-5778
Signed By Date
1/4/2019
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