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PROACT PHARMACY SERVICES, INC.
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
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
12/10/2024
Duplicate contract pharmacy record
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
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