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WALMART PHARMACY 10-4597
DSH330078 SISTERS OF CHARITY HOSPITAL
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Covered Entity Details
Entity Name
SISTERS OF CHARITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330078
Entity Address
2157 MAIN STREET
BUFFALO, NY 14214
Medicare Provider Number
330078
Participating Start Date
1/1/2014
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-4597
Pharmacy Address
886 NIAGARA FALLS BLVD.
NORTH TONAWANDA, NY 14120
Pharmacy Comments
Contract Details
Approval Date
4/1/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Osborne, Vice President, Finance
(716) 828-2011
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/1/2020
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