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WEGMANS FOOD MARKETS, INC.
DSH330307 CAYUGA MEDICAL CENTER AT ITHACA
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Covered Entity Details
Entity Name
CAYUGA MEDICAL CENTER AT ITHACA
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330307
Entity Address
101 DATES DRIVE
ITHACA, NY 14850
Medicare Provider Number
330307
Participating Start Date
7/1/2019
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WEGMANS FOOD MARKETS, INC.
Pharmacy Address
500 SOUTH MEADOW STREET
ATTN: PHARMACY
ITHACA, NY 14850
Pharmacy Comments
Contract Details
Approval Date
4/4/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
John Collett, CHIEF FINANCIAL OFFICER
(607) 274-4441
Contract Pharmacy Representative
Wegmans Ithaca Pharmacy
Joanna Marsh, Supervising Pharmacist
(585) 239-2046
Signed By Date
4/4/2018
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