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TOPS MARKETS
DSH330065C NIAGARA FALLS MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
NIAGARA FALLS MEMORIAL MEDICAL CENTER
Subdivision Name
PORTER ROAD LABORATORY DRAW STATION
Type
Disproportionate Share Hospital
340B ID
DSH330065C
Entity Address
7751 PORTER ROAD
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
8/6/2010
Contract Begin Date
8/6/2010
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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