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SPRINGVILLE PHARMACY INFUSION THERAPY, I
DSH330103 OLEAN GENERAL HOSPITAL
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Covered Entity Details
Entity Name
OLEAN GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330103
Entity Address
515 MAIN STREET
OLEAN, NY 14760
Medicare Provider Number
330103
Participating Start Date
10/1/2019
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
SPRINGVILLE PHARMACY INFUSION THERAPY, I
Pharmacy Address
OPTION CARE
40 CENTRE DRIVE
ORCHARD PARK, NY 14127-4100
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard G. Braun Jr., SVP Finance and CFO
(716) 375-6190
Contract Pharmacy Representative
Option Care Health
Jennifer Money, Manager, Health Systems Programs
(312) 940-2504
Signed By Date
4/15/2020
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