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CATHOLIC HEALTH SYSTEM INFUSION PHARMACY
DSH330188R Mount St. Mary's Hospital and Health Center
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Covered Entity Details
Entity Name
Mount St. Mary's Hospital and Health Center
Subdivision Name
MSM HEALTH CENTER LOCKPORT - HEALTH CENTER
Type
Disproportionate Share Hospital
340B ID
DSH330188R
Entity Address
6000 BROCKTON DR
STE 106
LOCKPORT, NY 14094-9273
Medicare Provider Number
330188
Outpatient Facility Provider Number
Participating Start Date
10/1/2019
Last Recertification Date
8/29/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
CATHOLIC HEALTH SYSTEM INFUSION PHARMACY
Pharmacy Address
D/B/A CATHOLIC HEALTH INFUSION PHARMACY
6350 TRANSIT RD
DEPEW, NY 14043
Pharmacy Comments
Contract Details
Approval Date
12/23/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
1/1/2020
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael Osborne, Vice President, Finance
(716) 828-2011
Contract Pharmacy Representative
HomeCare - Catholic Health System
Joyce Markiewicz, President and CEO HomeCare
(716) 706-2305
Signed By Date
12/23/2019
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