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WAL-MART PHARMACY 10-2547
DSH330386 Garnet Health Medical Center - Catskills
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Covered Entity Details
Entity Name
Garnet Health Medical Center - Catskills
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330386
Entity Address
68 HARRIS BUSHVILLE ROAD
HARRIS, NY 12742-0000
Medicare Provider Number
330386
Participating Start Date
1/1/2007
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2547
Pharmacy Address
41 ANAWANA LAKE ROAD
MONTICELLO, NY 12701
Pharmacy Comments
Contract Details
Approval Date
1/4/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/31/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jonathan Schiller, Chief Executive Officer
(845) 794-3300 Ext: 2100
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/4/2019
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