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ADIRONDACK APOTHECARY, LLC
CAH331302-00 ELIZABETHTOWN COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
ELIZABETHTOWN COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331302-00
Entity Address
75 PARK STREET
ELIZABETHTOWN, NY 12932
Medicare Provider Number
331302
Participating Start Date
9/30/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
ADIRONDACK APOTHECARY, LLC
Pharmacy Address
DBA: WILLSBORO PHARMACY
3932 NYS RT22
WILLSBORO, NY 12996
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
12/30/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
12/29/2010
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