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PARKVIEW NIAGARA STREET, LLC
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
PARKVIEW NIAGARA STREET, LLC
Pharmacy Address
DBA RIVERVIEW PROFESSIONAL PHARMACY
3920 MAIN ST STE 150
AMHERST, NY 14226
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Osborne, Vice President, Finance
(716) 828-2011
Contract Pharmacy Representative
Riverview Professional Pharmacy
Justin Waclawek, Pharmacist
(866) 435-0049
Signed By Date
10/14/2022
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