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RITE AID DRUG PALACE, INC.
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
RITE AID DRUG PALACE, INC.
Pharmacy Address
RITE AID #763
DEL-TON PLAZA
4220 DELAWARE AVE
TONAWANDA, NY 14150
Pharmacy Comments
Contract Details
Approval Date
11/9/2012
Contract Begin Date
10/27/2012
Carve-In Effective Date
Contract Comments
11/07/2012 - public health emergency declared in the state of NY effective 10/27/2012
Contract Termination Date
Termination Reason
12/28/2017
Agreement registered in error
Contacts
Covered Entity Signing Official
Raj Mehta, CFO/Vice President of Finance
(716) 278-4399
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
10/15/2012
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