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MARTIN'S FOODS OF SOUTH BURLINGTON, LLC
CAH331305-00 O'Connor Hospital
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Covered Entity Details
Entity Name
O'Connor Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331305-00
Entity Address
460 Andes Road
Delhi, NY 13753
Medicare Provider Number
331305
Participating Start Date
2/13/2013
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
MARTIN'S FOODS OF SOUTH BURLINGTON, LLC
Pharmacy Address
DBA HANNAFORD SUPERMARKET & PHARMACY #83
705 STATE HWY 28
ONEONTA, NY 13820
Pharmacy Comments
Contract Details
Approval Date
4/21/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/12/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Guy DiStefano, VP of Financial Operations
(607) 547-3692
Contract Pharmacy Representative
Hannaford
Dan Fadden, 340B Program Manager
(845) 392-8959
Signed By Date
4/21/2023
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