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WAL-MART PHARMACY 10-1926
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
WAL-MART PHARMACY 10-1926
Pharmacy Address
341 ROUTE 104 EAST
OSWEGO, NY 13126
Pharmacy Comments
Contract Details
Approval Date
1/15/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel T. Dey, CEO
(315) 298-6569 Ext: 2003
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/15/2014
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