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GLENS FALLS HOSPITAL INC
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
GLENS FALLS HOSPITAL INC
Pharmacy Address
100 PARK ST
GLENS FALLS, NY 12801-4413
Pharmacy Comments
Contract Details
Approval Date
10/3/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
George Purdue, Chief Administrative Officer
(518) 761-0300 Ext: 31114
Contract Pharmacy Representative
Glens Falls Hospital Inc.
Nancy H Huntington, Supervising Pharmacist
(518) 926-2501
Signed By Date
10/3/2013
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