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QUINLANS LONG TERM CARE
SCH330008-00 WYOMING COUNTY COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
WYOMING COUNTY COMMUNITY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH330008-00
Entity Address
400 NORTH MAIN STREET
WARSAW, NY 14569
Medicare Provider Number
330008
Participating Start Date
1/1/2024
Last Recertification Date
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
QUINLANS LONG TERM CARE
Pharmacy Address
107 N MAIN ST
SUITE B
WAYLAND, NY 14572-1033
Pharmacy Comments
Contract Details
Approval Date
1/12/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mark Wright, Chief Financial Officer
(585) 786-8940
Contract Pharmacy Representative
Quinlans Long Term Care
John Quinlan, Pharmacist
(585) 243-3510
Signed By Date
1/12/2024
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