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TOPS MARKETS
DSH330065A NIAGARA FALLS MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
NIAGARA FALLS MEMORIAL MEDICAL CENTER
Subdivision Name
SUMMIT HEALTH FAMILY PRACTICE
Type
Disproportionate Share Hospital
340B ID
DSH330065A
Entity Address
6932-6934 WILLIAMS RD
200
Niagara Falls, NY 14304
Medicare Provider Number
330065
Outpatient Facility Provider Number
Participating Start Date
7/1/2007
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
TOPS MARKETS
Pharmacy Address
2140 GRAND ISLAND BLVD
GRAND ISLAND, NY 14072
Pharmacy Comments
Contract Details
Approval Date
8/15/2010
Contract Begin Date
8/15/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
FRANK WOLFF, DIRECTOR OF PHARMACY
(716) 635-5275
Signed By Date
8/1/2010
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