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COMMCARE PHARMACY-FTL, LLC
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
COMMCARE PHARMACY-FTL, LLC
Pharmacy Address
855 SW 78TH AVE STE C100
PLANTATION, FL 33324-3223
Pharmacy Comments
Contract Details
Approval Date
7/14/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/3/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Jonathan Thomas Swiatkowski, EVP, Chief Financial Officer
(716) 859-8836
Contract Pharmacy Representative
Commcare Pharmacy
Avani Patel, Client Relations Manager
(561) 310-4324
Signed By Date
7/14/2016
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