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WEGMANS FOOD MARKETS, INC.
DSH330241 UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330241
Entity Address
750 East Adams Street
Syracuse, NY 13210
Medicare Provider Number
330241
Participating Start Date
7/1/2005
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WEGMANS FOOD MARKETS, INC.
Pharmacy Address
6789 E. GENESEE STREET
ATTN: PHARMACY
FAYETTEVILLE, NY 13066
Pharmacy Comments
02/01/2012 changed store #(was 130)
Contract Details
Approval Date
1/15/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Seale, Chief Operating Officer
(315) 464-6530
Contract Pharmacy Representative
Pharmacy Business Relations Mgr
Brian Pompo, Pharmacy Business Relations Manager
(315) 546-1100 Ext: 431
Signed By Date
1/15/2014
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