Contract Pharmacy Details

PARKVIEW NIAGARA STREET, LLC
DSH330219B ERIE COUNTY MEDICAL CENTER

Covered Entity Details

Entity Name

ERIE COUNTY MEDICAL CENTER

Subdivision Name

ERIE COUNTY MEDICAL CENTER CORPORAT - Depew Chemical Dependency

Type

Disproportionate Share Hospital

340B ID

DSH330219B

Entity Address

5087 BROADWAY
ECMC CHEMICAL DEPENDENCY CLINIC
DEPEW, NY 14043-4013

Medicare Provider Number

330219

Outpatient Facility Provider Number

Participating Start Date

7/1/2019

Last Recertification Date

8/17/2023

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

340B Drug Pricing Program Database