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OSWEGO VALLEY PHARMACY INC
CH020870 NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC
Subdivision Name
NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH020870
Entity Address
61 Delano St
Pulaski, NY 13142-1400
Grant Number
H80CS00166
Participating Start Date
10/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OSWEGO VALLEY PHARMACY INC
Pharmacy Address
THE MEDICINE PLACE
464 MAIN ST
PHOENIX, NY 13135
Pharmacy Comments
Contract Details
Approval Date
10/9/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel T. Dey, CEO
(315) 298-6569 Ext: 2003
Contract Pharmacy Representative
Medicine Place
DAVID DINGMAN, OPH OWNER
(315) 695-4200
Signed By Date
10/9/2013
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