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UPSTATE PHARMACY LTD
DSH330219 ERIE COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
ERIE COUNTY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330219
Entity Address
462 Grider Street
BUFFALO, NY 14215
Medicare Provider Number
330219
Participating Start Date
4/1/1996
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
UPSTATE PHARMACY LTD
Pharmacy Address
THADDEUS KUZNIAREK
1900 N AMERICA DR
SUITE 100
WEST SENECA, NY 14224-5310
Pharmacy Comments
Contract Details
Approval Date
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/9/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jonathan Thomas Swiatkowski, Chief Financial Officer
(716) 898-6291
Contract Pharmacy Representative
Upstate Pharmacy LTD
Thaddeus Kuzniarek, Vice President/Owner
(716) 675-3784
Signed By Date
1/13/2020
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