340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
GOLUB CORPORATION
DSH330211 CLAXTON HEPBURN MEDICAL CENTER
Print
Covered Entity Details
Entity Name
CLAXTON HEPBURN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330211
Entity Address
214 KING STREET
OGDENSBURG, NY 13669
Medicare Provider Number
330211
Participating Start Date
4/1/2022
Last Recertification Date
9/5/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
GOLUB CORPORATION
Pharmacy Address
PRICE CHOPPER PHARMACY #030
2981 FORD STREET EXT, SUITE 9
OGDENSBURG, NY 13669-4455
Pharmacy Comments
Contract Details
Approval Date
4/11/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/23/2024
Ownership change
Contacts
Covered Entity Signing Official
Richard Duvall, CEO
(315) 713-5237
Contract Pharmacy Representative
Golub Corporation
Scott Guisinger, Vice President of Pharmacy
(518) 379-2409
Signed By Date
4/11/2022
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session