340B Drug Pricing Program Database
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NOBLE HEALTH SERVICES INC.
DSH330073 UNITED MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
UNITED MEMORIAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330073
Entity Address
127 NORTH STREET
BATAVIA, NY 14020
Medicare Provider Number
330073
Participating Start Date
1/1/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
NOBLE HEALTH SERVICES INC.
Pharmacy Address
6040 TARBELL ROAD
SYRACUSE, NY 13206
Pharmacy Comments
Contract Details
Approval Date
7/14/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hugh Thomas, Executive Vice President, Chief Administrative Officer
(585) 922-4941
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
7/14/2019
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