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DSH330163 EASTERN NIAGARA HOSPITAL (Terminated)
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Main Details
Name
EASTERN NIAGARA HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330163
Medicare Provider Number
330163
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2021
Participating Start Date
4/16/2021
Participating Approval Date
4/16/2021
Last Recertification Date
8/16/2021
Termination Date
Termination Reason
1/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Catholic Health System
Michael Osborne, Vice President, Finance
(716) 828-2011
Primary Contact
Catholic Health System
Tristan Diane Greer, 340B Program Business Manager
(716) 923-2920
Addresses
Street Address
521 EAST AVENUE
LOCKPORT, NY 14094
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (01/01/2018), until terminated effective date: (10/1/2019), reinstatement date: (04/16/2021)
04/16/2021
April 2025
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