Contract Pharmacy Details

ECKERD CORPORATION
DSH330090 ARNOT OGDEN MEDICAL CENTER

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

ECKERD CORPORATION

Pharmacy Address

RITE AID #10887
209 MOUNT ZOAR STREET
ELMIRA, NY 14904

Pharmacy Comments

Contract Details

Approval Date

1/7/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Ron Dokken, Vice President of Clinical Affairs
(607) 737-4152

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

1/7/2020

340B Drug Pricing Program Database