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SUMMIT PARK PHARMACY
DSH330065 NIAGARA FALLS MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
NIAGARA FALLS MEMORIAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330065
Entity Address
621-10TH STREET
NIAGARA FALLS, NY 14302
Medicare Provider Number
330065
Participating Start Date
10/1/2006
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
SUMMIT PARK PHARMACY
Pharmacy Address
2578 NIAGRA FALLS BLVD
SUITE 100
NIAGRA FALLS, NY 14304
Pharmacy Comments
Contract Details
Approval Date
8/17/2010
Contract Begin Date
8/17/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
8/10/2010
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