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THE GOLUB CORPORATION
RRC330094-00 Columbia Memorial Hospital
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Covered Entity Details
Entity Name
Columbia Memorial Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC330094-00
Entity Address
71 Prospect Aveune
Hudson, NY 12534
Medicare Provider Number
330094
Participating Start Date
10/1/2013
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
THE GOLUB CORPORATION
Pharmacy Address
PRICE CHOPPER PHARMACY 246
2614 ROUTE 66
CHATHAM, NY 12037
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
10/31/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bryan T. Mahoney, Chief Financial Officer
(518) 697-3230
Contract Pharmacy Representative
Golub Corporation
Scott Guisinger, Vice President of Pharmacy
(518) 379-2409
Signed By Date
10/14/2022
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