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ECKERD CORPORATION
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
ECKERD CORPORATION
Pharmacy Address
RITE AID #10826
291 WEST FERRY STREET
BUFFALO, NY 14213
Pharmacy Comments
Contract Details
Approval Date
4/17/2023
Contract Begin Date
5/3/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/12/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Matthew D Drake, EVP Chief Financial Officer
(716) 859-8836
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President Managed Care
(717) 975-5978
Signed By Date
4/17/2023
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