Contract Pharmacy Details

HEALTHDIRECT INSTITUTIONAL PHARMACY SERV
DSH330084 ALICE HYDE MEDICAL CENTER

Covered Entity Details

Entity Name

ALICE HYDE MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330084

Entity Address

133 PARK STREET
MALONE, NY 12953-0729

Medicare Provider Number

330084

Participating Start Date

10/1/2011

Last Recertification Date

8/29/2023

Entity Termination Date

11/27/2023

Pharmacy Details

Pharmacy Name

HEALTHDIRECT INSTITUTIONAL PHARMACY SERV

Pharmacy Address

HEALTHDIRECT INSTITUTIONAL PHARMACY SERV
29 E MAIN ST
GOUVERNEUR, NY 13642

Pharmacy Comments

10/25/10 UPDATED ADDR (WAS GOVERNEUR);

Contract Details

Approval Date

9/14/2012

Contract Begin Date

9/14/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/13/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Chris Frauenhofer, V.P. of Finance
(518) 481-2204

Contract Pharmacy Representative

Kinney Drugs
Debbi Barber, Director of Pharmacy Programs
(315) 287-3600 Ext: 2423

Signed By Date

8/31/2012

340B Drug Pricing Program Database