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JEFFERSON PHARMACY INC.
DSH330386 Garnet Health Medical Center - Catskills
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Covered Entity Details
Entity Name
Garnet Health Medical Center - Catskills
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330386
Entity Address
68 HARRIS BUSHVILLE ROAD
HARRIS, NY 12742-0000
Medicare Provider Number
330386
Participating Start Date
1/1/2007
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
JEFFERSON PHARMACY INC.
Pharmacy Address
4892 STATE ROUTE 52
JEFFERSONVILLE, NY 12748
Pharmacy Comments
Contract Details
Approval Date
5/19/2020
Contract Begin Date
5/20/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jonathan Schiller, Chief Executive Officer
(845) 794-3300 Ext: 2100
Contract Pharmacy Representative
Jefferson Pharmacy
Sonal Trivedi, Pharmacist
(845) 482-5720
Signed By Date
5/19/2020
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