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TRINITY HEALTH PHARMACY SERVICES, LLC
DSH330057 ST. PETERS HOSPITAL
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Covered Entity Details
Entity Name
ST. PETERS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330057
Entity Address
315 S. MANNING BLVD.
ALBANY, NY 12208
Medicare Provider Number
330057
Participating Start Date
4/1/2024
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
TRINITY HEALTH PHARMACY SERVICES, LLC
Pharmacy Address
12279 BLUFFTON RD
FORT WAYNE, IN 46809-3208
Pharmacy Comments
Contract Details
Approval Date
4/9/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lori Santos, CFO
(518) 525-5537
Contract Pharmacy Representative
TRINITY HEALTH
ZACHARY ROBERTS, DIRECTOR OF SPECIALTY PHARMACY
(734) 343-7606
Signed By Date
4/9/2024
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