340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PROACT PHARMACY SERVICES, INC.
CAH331302-00 ELIZABETHTOWN COMMUNITY HOSPITAL
Print
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
PROACT PHARMACY SERVICES, INC.
Pharmacy Address
1226 US HIGHWAY 11
GOUVERNEUR, NY 13642
Pharmacy Comments
Contract Details
Approval Date
1/13/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/16/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RODNEY BOULA, CEO
(518) 873-3002
Contract Pharmacy Representative
Kinney Drugs
Debbi Barber, Director of Pharmacy Programs
(315) 287-3600 Ext: 2423
Signed By Date
1/13/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session