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MAGGY PHARMACY INC
DSH330250 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL
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Covered Entity Details
Entity Name
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330250
Entity Address
75 BEEKMAN STREET
PLATTSBURGH, NY 12901
Medicare Provider Number
330250
Participating Start Date
6/3/2019
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
MAGGY PHARMACY INC
Pharmacy Address
MAGGY MARKETPLACE DBA
1165 ROUTE 374 COOK ST.
P.O. BOX 369
DANNEMORA, NY 12929
Pharmacy Comments
Contract Details
Approval Date
5/31/2019
Contract Begin Date
6/3/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michelle M LeBeau, President/Chief Operations officer
(518) 562-7055
Contract Pharmacy Representative
Maggy Pharmacy
Michael Maggy, President
(518) 492-7130
Signed By Date
4/14/2019
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