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SPECIALTY PHARMACY MANAGEMENT, LLC
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
SPECIALTY PHARMACY MANAGEMENT, LLC
Pharmacy Address
15 EARHART DR STE 101
AMHERST, NY 14221-7079
Pharmacy Comments
Contract Details
Approval Date
4/27/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Raj Mehta, CFO/Vice President of Finance
(716) 278-4399
Contract Pharmacy Representative
Amy Nash, President
(716) 929-1000
Signed By Date
4/27/2017
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