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CMV PHARMACY INC.
CAH331316-00 COMMUNITY MEMORIAL HOSPITAL INC.
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Covered Entity Details
Entity Name
COMMUNITY MEMORIAL HOSPITAL INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331316-00
Entity Address
150 BROAD ST
HAMILTON, NY 13346
Medicare Provider Number
331316
Participating Start Date
4/1/2015
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CMV PHARMACY INC.
Pharmacy Address
DBA DOUGHERTY PHARMACY
14 E MAIN ST.
PO BOX 237
MORRISVILLE, NY 13408
Pharmacy Comments
Contract Details
Approval Date
10/14/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sean Fadale, President and CEO
(315) 824-6080
Contract Pharmacy Representative
Dougherty Pharmacy
Colin Valenta, Owner
(315) 825-9800
Signed By Date
10/14/2015
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