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PHARMACY ASSOC OF GLENS FALLS
DSH330047 ST. MARYS HEALTHCARE
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Covered Entity Details
Entity Name
ST. MARYS HEALTHCARE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330047
Entity Address
427 GUY PARK AVENUE
AMSTERDAM, NY 12010
Medicare Provider Number
330047
Participating Start Date
10/1/2009
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
PHARMACY ASSOC OF GLENS FALLS
Pharmacy Address
OMNICARE OF BALLSTON SPA
14 COMMERCE DR
BALLSTON SPA, NY 12020-3631
Pharmacy Comments
Contract Details
Approval Date
4/1/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Keith Waters, Vice President of Finance/CFO
(518) 770-7583
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/1/2022
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