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MATTHEWS PHARMACY
CAH331310-00 ELLENVILLE REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
ELLENVILLE REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331310-00
Entity Address
10 HEALTHY WAY
ELLENVILLE, NY 12428-5612
Medicare Provider Number
331310
Participating Start Date
7/1/2011
Last Recertification Date
11/29/2017
Entity Termination Date
10/1/2018
Pharmacy Details
Pharmacy Name
MATTHEWS PHARMACY
Pharmacy Address
101 CANAL ST
ELLENVILLE, NY 12428
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
7/1/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
7/1/2011
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