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PARKVIEW NIAGARA STREET, LLC
DSH330219G ERIE COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
ERIE COUNTY MEDICAL CENTER
Subdivision Name
Dental-BGH - Dental-BGH
Type
Disproportionate Share Hospital
340B ID
DSH330219G
Entity Address
100 High Street
Buffalo, NY 14203
Medicare Provider Number
330219
Outpatient Facility Provider Number
Participating Start Date
10/1/2019
Last Recertification Date
8/31/2023
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
PARKVIEW NIAGARA STREET, LLC
Pharmacy Address
DBA RIVERVIEW PROFESSIONAL PHARMACY
3920 MAIN ST STE 150
AMHERST, NY 14226
Pharmacy Comments
Contract Details
Approval Date
8/3/2021
Contract Begin Date
8/5/2021
Carve-In Effective Date
10/1/2021
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jonathan Thomas Swiatkowski, Chief Financial Officer
(716) 898-6291
Contract Pharmacy Representative
Parkview Health Services
Justin Walclawek, Director of Pharmacy
(716) 876-2323 Ext: 282
Signed By Date
8/3/2021
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