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WURLITZER FAMILY PHARMACY INC.
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
WURLITZER FAMILY PHARMACY INC.
Pharmacy Address
521 DIVISION ST
NORTH TONAWANDA, NY 14120
Pharmacy Comments
Contract Details
Approval Date
4/8/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jonathan Thomas Swiatkowski, EVP, Chief Financial Officer
(716) 859-8836
Contract Pharmacy Representative
Rachel Giroux, Pharmacist
(716) 260-1131
Signed By Date
4/8/2014
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