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THE GOLUB CORPORATION
CH02179F HUDSON HEADWATERS HEALTH NETWORK
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Covered Entity Details
Entity Name
HUDSON HEADWATERS HEALTH NETWORK
Subdivision Name
TICONDEROGA HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH02179F
Entity Address
101 Adirondack Drive
Suite 2
TICONDEROGA, NY 12883-9334
Grant Number
H80CS00159
Participating Start Date
4/1/2001
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
THE GOLUB CORPORATION
Pharmacy Address
PRICE CHOPPER PHARMACY 040
677 GLEN ST
QUEENSBURY, NY 12804
Pharmacy Comments
01/27/2012 updated CP address (was US RTE 9 AND UPPER GLEN STREET GLENS FALLS NY 12801)
Contract Details
Approval Date
1/1/2002
Contract Begin Date
1/1/2002
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
George Purdue, Chief Administrative Officer
(518) 761-0300 Ext: 31114
Contract Pharmacy Representative
Golub Corporation
Scott Guisinger, Vice President of Pharmacy
(518) 379-2409
Signed By Date
8/20/2012
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