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WAL-MART PHARMACY 10-1705
DSH330285 STRONG MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
STRONG MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330285
Entity Address
601 Elmwood Avenue
ROCHESTER, NY 14642
Medicare Provider Number
330285
Participating Start Date
10/1/2003
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1705
Pharmacy Address
1860 NORTH ROAD
WATERLOO, NY 13165
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
4/21/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carrie Fuller Spencer, Chief Financial Officer
(585) 275-3033
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2020
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