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CORAM HEALTHCARE CORPORATION OF GREATER
DSH330078 SISTERS OF CHARITY HOSPITAL
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Covered Entity Details
Entity Name
SISTERS OF CHARITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330078
Entity Address
2157 MAIN STREET
BUFFALO, NY 14214
Medicare Provider Number
330078
Participating Start Date
1/1/2014
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
CORAM HEALTHCARE CORPORATION OF GREATER
Pharmacy Address
DBA CORAM CVS/SPECIALTY INFUSION SERVICE
2949 ERIE BLVD EAST
SUITE 103
SYRACUSE, NY 13224
Pharmacy Comments
Contract Details
Approval Date
4/11/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Michael Osborne, Vice President, Finance
(716) 828-2011
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/11/2024
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