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WAYNE DRUG OF PULASKI INC
SCH330218-00 Oswego Hospital
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Covered Entity Details
Entity Name
Oswego Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH330218-00
Entity Address
110 West 6th Street
Oswego, NY 13126
Medicare Provider Number
330218
Participating Start Date
12/2/2011
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAYNE DRUG OF PULASKI INC
Pharmacy Address
DBA WAYNE DRUG OSWEGO CO
24 W BRIDGE ST
OSWEGO, NY 13126-2051
Pharmacy Comments
Contract Details
Approval Date
7/6/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/14/2024
Ownership change
Contacts
Covered Entity Signing Official
Eric T. Campbell, CFO
(315) 349-5531
Contract Pharmacy Representative
Wayne Drugs
Cassi Munger, Office Manager
(315) 343-5722
Signed By Date
7/6/2023
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