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PARKVIEW NIAGARA STREET, LLC
DSH330065 NIAGARA FALLS MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
NIAGARA FALLS MEMORIAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330065
Entity Address
621-10TH STREET
NIAGARA FALLS, NY 14302
Medicare Provider Number
330065
Participating Start Date
10/1/2006
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
PARKVIEW NIAGARA STREET, LLC
Pharmacy Address
DBA RIVERVIEW PROFESSIONAL PHARMACY
3920 MAIN ST STE 150
AMHERST, NY 14226
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Raj Mehta, CFO/Vice President of Finance
(716) 278-4399
Contract Pharmacy Representative
Parkview Health Services
Kevin O'Leary, President
(716) 876-2323
Signed By Date
7/15/2019
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