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WAL-MART PHARMACY 10-2088
DSH330073 UNITED MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
UNITED MEMORIAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330073
Entity Address
127 NORTH STREET
BATAVIA, NY 14020
Medicare Provider Number
330073
Participating Start Date
1/1/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2088
Pharmacy Address
4133 VETERANS MEMORIAL DRIVE
BATAVIA, NY 14020
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert L. Chiavetta, CFO
(585) 344-5249
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2018
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