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NOBLE HEALTH SERVICES INC.
SCH330175-00 GUTHRIE CORTLAND MEDICAL CENTER
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Covered Entity Details
Entity Name
GUTHRIE CORTLAND MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH330175-00
Entity Address
134 HOMER AVENUE
CORTLAND, NY 13045
Medicare Provider Number
330175
Participating Start Date
10/1/2023
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
NOBLE HEALTH SERVICES INC.
Pharmacy Address
6040 TARBELL ROAD
SYRACUSE, NY 13206
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/15/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Denise Wrinn, Vice President Finance/CFO
(607) 756-3526
Contract Pharmacy Representative
The Guthrie Clinic
Matthew David Denniston, VP, Pharmacy Services
(570) 887-6626
Signed By Date
1/15/2020
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