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WEGMANS FOOD MARKETS, INC.
DSH330078 SISTERS OF CHARITY HOSPITAL
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Covered Entity Details
Entity Name
SISTERS OF CHARITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330078
Entity Address
2157 MAIN STREET
BUFFALO, NY 14214
Medicare Provider Number
330078
Participating Start Date
1/1/2014
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WEGMANS FOOD MARKETS, INC.
Pharmacy Address
4960 TRANSIT ROAD
ATTN: PHARMACY
DEPEW, NY 14043
Pharmacy Comments
Contract Details
Approval Date
10/16/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/4/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James A. Dunlop Jr., CFO
(716) 862-2431
Contract Pharmacy Representative
Pharmacy Business Relations Mgr
Brian Pompo, Pharmacy Business Relations Manager
(315) 546-1100 Ext: 431
Signed By Date
10/16/2014
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