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FAMILY PHARMACEUTICAL SER
DSH330005 KALEIDA HEALTH
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Covered Entity Details
Entity Name
KALEIDA HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330005
Entity Address
100 High Street
BUFFALO, NY 14203
Medicare Provider Number
330005
Participating Start Date
4/1/2006
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
FAMILY PHARMACEUTICAL SER
Pharmacy Address
1001 MAIN ST.
2ND FLOOR
BUFFALO, NY 14203
Pharmacy Comments
01/25/2013 name update, DEA normalization (was FPS - Childrens Home Care Pharmacy)
Contract Details
Approval Date
10/18/2011
Contract Begin Date
10/18/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/27/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Jonathan Thomas Swiatkowski, EVP, Chief Financial Officer
(716) 859-8836
Contract Pharmacy Representative
Lawrence Zielinski, President
(716) 859-3384
Signed By Date
10/13/2011
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