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ADIRONDACK APOTHECARY LLC
CAH331302-01 ELIZABETHTOWN COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
ELIZABETHTOWN COMMUNITY HOSPITAL
Subdivision Name
ELIZABETHTOWN COMMUNITY HEALTH CENTER
Type
Critical Access Hospital
340B ID
CAH331302-01
Entity Address
66 PARK STREET
ELIZABETHTOWN, NY 12932
Medicare Provider Number
331302
Outpatient Facility Provider Number
Participating Start Date
9/30/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
ADIRONDACK APOTHECARY LLC
Pharmacy Address
D B A MORIAH PHARMACY
4315 MAIN ST
PORT HENRY, NY 12974-1339
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
12/30/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/10/2024
Duplicate contract pharmacy record
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
12/29/2010
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