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NOBLE HEALTH SERVICES INC.
DSH330115 ONEIDA HEALTHCARE CENTER
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Covered Entity Details
Entity Name
ONEIDA HEALTHCARE CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330115
Entity Address
321 GENESEE STREET
ONEIDA, NY 13421
Medicare Provider Number
330115
Participating Start Date
1/1/2015
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
NOBLE HEALTH SERVICES INC.
Pharmacy Address
6040 TARBELL ROAD
SYRACUSE, NY 13206
Pharmacy Comments
Contract Details
Approval Date
4/4/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/4/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Milligan, CFO
(315) 361-2088
Contract Pharmacy Representative
Debbi Barber, Director of PBM Relations
(315) 287-3600 Ext: 2423
Signed By Date
4/4/2016
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