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MARTIN'S FOODS OF SOUTH BURLINGTON, LLC
DSH330136 MARY IMOGENE BASSETT HOSPITAL
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Covered Entity Details
Entity Name
MARY IMOGENE BASSETT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330136
Entity Address
1 ATWELL ROAD
COOPERSTOWN, NY 13326
Medicare Provider Number
330136
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
MARTIN'S FOODS OF SOUTH BURLINGTON, LLC
Pharmacy Address
DBA HANNAFORD SUPERMARKET & PHARMACY #83
705 STATE HWY 28
ONEONTA, NY 13820
Pharmacy Comments
Contract Details
Approval Date
10/8/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Paul Swinko, CFO
(607) 547-3096
Contract Pharmacy Representative
Hannaford
Mike Fish, Pharmacy District Manager
(518) 428-2712
Signed By Date
10/6/2021
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