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PRICE CHOPPER OPERATING CO., INC.
DSH330191 GLENS FALLS HOSPITAL
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Covered Entity Details
Entity Name
GLENS FALLS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330191
Entity Address
100 PARK ST
GLENS FALLS, NY 12801
Medicare Provider Number
330191
Participating Start Date
10/1/2022
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
PRICE CHOPPER OPERATING CO., INC.
Pharmacy Address
HOUSECALLS PHARMACY 201
3761 MAIN STREET
WARRENSBURG, NY 12885
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
10/21/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mitchell J Amado, VP, Senior, Finance & CFO
(518) 926-5113
Contract Pharmacy Representative
Golub Corporation
Scott Guisinger, Vice President of Pharmacy
(518) 379-2409
Signed By Date
10/13/2022
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