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31ST & 3RD PHARMACY INC
DSH330078AU SISTERS OF CHARITY HOSPITAL
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Covered Entity Details
Entity Name
SISTERS OF CHARITY HOSPITAL
Subdivision Name
Sisters Health Center D'Youville - Primary Care
Type
Disproportionate Share Hospital
340B ID
DSH330078AU
Entity Address
301 Connecticut Street
Buffalo, NY 14213
Medicare Provider Number
330078
Outpatient Facility Provider Number
Participating Start Date
10/1/2022
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
31ST & 3RD PHARMACY INC
Pharmacy Address
D/B/A AVITA PHARMACY 1063
1860 WALT WHITMAN RD STE 700
MELVILLE, NY 11747
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
1/1/2023
Contract Comments
Contacts
Covered Entity Signing Official
Michael Osborne, Vice President, Finance
(716) 828-2011
Contract Pharmacy Representative
Paramount Pharmacy
John F. Civitello, 340B Program Director
(631) 815-5778
Signed By Date
10/17/2022
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