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CATHOLIC HEALTH SYSTEM INFUSION PHARMACY
DSH330188E Mount St. Mary's Hospital and Health Center
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Covered Entity Details
Entity Name
Mount St. Mary's Hospital and Health Center
Subdivision Name
Mount St. Mary's Orthopedic Services
Type
Disproportionate Share Hospital
340B ID
DSH330188E
Entity Address
5320 Military Road, Suite 107
Lewiston, NY 14092
Medicare Provider Number
330188
Outpatient Facility Provider Number
Participating Start Date
1/1/2014
Last Recertification Date
8/30/2024
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
3/9/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
4/1/2022
Contract Comments
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
3/9/2022
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