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WEGMANS FOOD MARKETS, INC.
DSH330203 CROUSE HOSPITAL
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Covered Entity Details
Entity Name
CROUSE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330203
Entity Address
736 IRVING AVE
SYRACUSE, NY 13210
Medicare Provider Number
330203
Participating Start Date
10/1/2023
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WEGMANS FOOD MARKETS, INC.
Pharmacy Address
4256 JAMES STREET
ATTN: PHARMACY
EAST SYRACUSE, NY 13057
Pharmacy Comments
Contract Details
Approval Date
9/13/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/6/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kevin Randall, Chief Financial Officer
(315) 470-7589
Contract Pharmacy Representative
Wegmans
Jordan Pugliese, Pharmacy Business Development Manager
(585) 273-6358
Signed By Date
9/8/2023
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