Contract Pharmacy Details

WAYNE DRUG OF PULASKI INC
CH020870 NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC

Covered Entity Details

Entity Name

NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC

Subdivision Name

NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.

Type

HRSA-Funded Health Center

340B ID

CH020870

Entity Address

61 Delano St
Pulaski, NY 13142-1400

Grant Number

H80CS00166

Participating Start Date

10/1/2004

Last Recertification Date

2/11/2025

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

7/7/2023

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

Tracy L Wimmer, VP/Chief Financial Officer
(315) 298-6569 Ext: 2020

Contract Pharmacy Representative

Wayne Drugs
Cassi Munger, Office Manager
(315) 343-5722

Signed By Date

7/7/2023

340B Drug Pricing Program Database