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WAL-MART PHARMACY 10-2444
DSH330044 MVHS, Inc. DBA: Wynn Hospital
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Covered Entity Details
Entity Name
MVHS, Inc. DBA: Wynn Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330044
Entity Address
111 Hospital Drive
Utica, NY 13502
Medicare Provider Number
330044
Participating Start Date
7/1/2014
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2444
Pharmacy Address
2024 GENESEE ST
ONEIDA, NY 13421
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/18/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Louis Aiello, Sr. VP Finance/ CFO
(315) 917-8213
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2019
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