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CATHOLIC HEALTH SYSTEM INFUSION PHARMACY
DSH330188G Mount St. Mary's Hospital and Health Center
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Covered Entity Details
Entity Name
Mount St. Mary's Hospital and Health Center
Subdivision Name
Mount St. Mary's Primary Care
Type
Disproportionate Share Hospital
340B ID
DSH330188G
Entity Address
5290 Military Road
Suite 8 Lower
Lewiston, NY 14092-1997
Medicare Provider Number
330188
Outpatient Facility Provider Number
Participating Start Date
1/1/2014
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
CATHOLIC HEALTH SYSTEM INFUSION PHARMACY
Pharmacy Address
D/B/A CATHOLIC HEALTH INFUSION PHARMACY
6350 TRANSIT RD
DEPEW, NY 14043
Pharmacy Comments
Contract Details
Approval Date
6/8/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
7/1/2018
Contract Comments
Contacts
Covered Entity Signing Official
Michael Osborne, Vice President, Finance
(716) 828-2011
Contract Pharmacy Representative
HomeCare - Catholic Health System
Joyce Markiewicz, President and CEO HomeCare
(716) 706-2305
Signed By Date
6/8/2018
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