340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
THE GOLUB CORPORATION
DSH330136 MARY IMOGENE BASSETT HOSPITAL
Print
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
THE GOLUB CORPORATION
Pharmacy Address
PRICE CHOPPER PHARMACY 161
5631 STATE HIGHWAY 12
NORWICH, NY 13815
Pharmacy Comments
Contract Details
Approval Date
7/13/2022
Contract Begin Date
10/1/2022
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
Price Chopper
Angel Adams, Pharmacy Manager
(607) 336-2588
Signed By Date
7/13/2022
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