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J HORN LLC
DSH330103 OLEAN GENERAL HOSPITAL
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Covered Entity Details
Entity Name
OLEAN GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330103
Entity Address
515 MAIN STREET
OLEAN, NY 14760
Medicare Provider Number
330103
Participating Start Date
10/1/2019
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
J HORN LLC
Pharmacy Address
DBA: DAN HORN PHARMACY & HEALTH SERVICES
111 E GREEN ST
OLEAN, NY 14760
Pharmacy Comments
Contract Details
Approval Date
8/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard G. Braun Jr., SVP Finance and CFO
(716) 375-6190
Contract Pharmacy Representative
Dan Horn Pharmacy
Joshua Hern, Pharmacist
(716) 376-6337
Signed By Date
7/11/2019
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