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NOBLE HEALTH SERVICES INC.
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
NOBLE HEALTH SERVICES INC.
Pharmacy Address
6040 TARBELL ROAD
SYRACUSE, NY 13206
Pharmacy Comments
Contract Details
Approval Date
4/2/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Vielkind, Vice President Finance
(315) 823-5281
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
4/2/2025
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