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ADIRONDACK APOTHECARY LLC
CH02179R HUDSON HEADWATERS HEALTH NETWORK
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Covered Entity Details
Entity Name
HUDSON HEADWATERS HEALTH NETWORK
Subdivision Name
Champlain Family Health
Type
HRSA-Funded Health Center
340B ID
CH02179R
Entity Address
828 State Route 11
Champlain, NY 12919-4819
Grant Number
H80CS00159
Participating Start Date
10/1/2012
Last Recertification Date
2/10/2025
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
11/9/2012
Contract Begin Date
10/27/2012
Carve-In Effective Date
Contract Comments
11/07/2012 - public health emergency declared in the state of NY effective 10/27/2012
Contacts
Covered Entity Signing Official
George Purdue, Chief Administrative Officer
(518) 761-0300 Ext: 31114
Contract Pharmacy Representative
Adirondack Apothecary
James Bowen, President
(518) 532-0005
Signed By Date
10/1/2012
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