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GENOA HEALTHCARE LLC
DSH330090 ARNOT OGDEN MEDICAL CENTER
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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
GENOA HEALTHCARE LLC
Pharmacy Address
17 E GENESEE ST STE 208
AUBURN, NY 13021
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/14/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Mark Dworsky, Vice President of Clinical Services
(607) 737-4152
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2021
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