Contract Pharmacy Details

HEALTHDIRECT INSTITUTIONAL PHARMACY SERV
SCH330079-00 Adirondack Medical Center

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

HEALTHDIRECT INSTITUTIONAL PHARMACY SERV

Pharmacy Address

HEALTHDIRECT INSTITUTIONAL PHARMACY SERV
29 E MAIN ST
GOUVERNEUR, NY 13642

Pharmacy Comments

10/25/10 UPDATED ADDR (WAS GOVERNEUR);

Contract Details

Approval Date

10/14/2021

Contract Begin Date

1/1/2022

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

10/14/2021

340B Drug Pricing Program Database