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THE GOLUB CORPORATION
CH02179I HUDSON HEADWATERS HEALTH NETWORK
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Covered Entity Details
Entity Name
HUDSON HEADWATERS HEALTH NETWORK
Subdivision Name
Moriah Health Center
Type
HRSA-Funded Health Center
340B ID
CH02179I
Entity Address
33 TOM PHELPS LANE
MINEVILLE, NY 12956
Grant Number
H80CS00159
Participating Start Date
1/1/2007
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
THE GOLUB CORPORATION
Pharmacy Address
PRICE CHOPPER PHARMACY 040
677 GLEN ST
QUEENSBURY, NY 12804
Pharmacy Comments
01/27/2012 updated CP address (was US RTE 9 AND UPPER GLEN STREET GLENS FALLS NY 12801)
Contract Details
Approval Date
11/9/2012
Contract Begin Date
10/27/2012
Carve-In Effective Date
Contract Comments
11/07/2012 - public health emergency declared in the state of NY effective 10/27/2012
Contacts
Covered Entity Signing Official
George Purdue, Chief Administrative Officer
(518) 761-0300 Ext: 31114
Contract Pharmacy Representative
Golub Corporation
Scott Guisinger, Vice President of Pharmacy
(518) 379-2409
Signed By Date
10/1/2012
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