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NOBLE HEALTH SERVICES INC.
SCH330079-00 Adirondack Medical Center
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Covered Entity Details
Entity Name
Adirondack Medical Center
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH330079-00
Entity Address
2233 State Route 86
Saranac Lake, NY 12983
Medicare Provider Number
330079
Participating Start Date
10/1/2015
Last Recertification Date
8/30/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
NOBLE HEALTH SERVICES INC.
Pharmacy Address
6040 TARBELL ROAD
SYRACUSE, NY 13206
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Robert Laba, Chief FInancial Officer
(518) 897-2305
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
7/15/2020
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