340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART STORES EAST LP
SCH330079-00 Adirondack Medical Center
Print
Covered Entity Details
Entity Name
Adirondack Medical Center
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH330079-00
Entity Address
2233 State Route 86
Saranac Lake, NY 12983
Medicare Provider Number
330079
Participating Start Date
10/1/2015
Last Recertification Date
8/30/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART STORES EAST LP
Pharmacy Address
DBA WALMART PHARMAYCY #10-3334
3222 STATE ROUTE 11
MALONE, NY 12953
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/18/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Laba, Chief FInancial Officer
(518) 897-2305
Contract Pharmacy Representative
Walmart
Jodi Prohofsky, Sr Director Payer Relations
(479) 739-1973
Signed By Date
7/15/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session