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CATHOLIC HEALTH SYSTEM INFUSION PHARMACY
DSH330078AQ SISTERS OF CHARITY HOSPITAL
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Covered Entity Details
Entity Name
SISTERS OF CHARITY HOSPITAL
Subdivision Name
OLV FAMILY CARE CENTER - OLV Family Care
Type
Disproportionate Share Hospital
340B ID
DSH330078AQ
Entity Address
227 RIDGE RD
LACKAWANNA, NY 14218-1156
Medicare Provider Number
330078
Outpatient Facility Provider Number
Participating Start Date
4/1/2021
Last Recertification Date
8/16/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
CATHOLIC HEALTH SYSTEM INFUSION PHARMACY
Pharmacy Address
CATHOLIC HEALTH RX AT SISTERS HOSPITAL
2157 MAIN ST
BUFFALO, NY 14214-2648
Pharmacy Comments
Contract Details
Approval Date
9/17/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
10/1/2021
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael Osborne, Vice President, Finance
(716) 828-2011
Contract Pharmacy Representative
HomeCare - Catholic Health System
Joyce Markiewicz, President and CEO HomeCare
(716) 706-2305
Signed By Date
9/17/2021
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