340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PROACT PHARMACY SERVICES, INC.
SCH330223-06 MASSENA MEMORIAL HOSPITAL
Print
Covered Entity Details
Entity Name
MASSENA MEMORIAL HOSPITAL
Subdivision Name
MMH NORFOLK CLINIC
Type
Sole Community Hospital
340B ID
SCH330223-06
Entity Address
42 WEST MAIN ST
NORFOLK, NY 13667
Medicare Provider Number
330223
Outpatient Facility Provider Number
Participating Start Date
4/1/2017
Last Recertification Date
8/19/2019
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
PROACT PHARMACY SERVICES, INC.
Pharmacy Address
1226 US HIGHWAY 11
GOUVERNEUR, NY 13642
Pharmacy Comments
Contract Details
Approval Date
3/24/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Patrick Facteau, CFO
(315) 769-4207
Contract Pharmacy Representative
KPH Health
ETHAN THOMAS, 340B COORDINATOR
(315) 287-3600
Signed By Date
3/24/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session