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TOPS MARKETS
DSH390009 SAINT VINCENT HEALTH CENTER
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Covered Entity Details
Entity Name
SAINT VINCENT HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390009
Entity Address
232 WEST 25TH STREET
ERIE, PA 16544-0002
Medicare Provider Number
390009
Participating Start Date
7/1/2008
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
TOPS MARKETS
Pharmacy Address
TOPS PHARMACY #601
1702 EAST 38TH STREET
ERIE, PA 16510
Pharmacy Comments
Contract Details
Approval Date
2/20/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
THOMAS FUCCI, EXECUTIVE VICE PRESIDENT AND CHIEF OPERATING OFFICER
(814) 452-5112
Contract Pharmacy Representative
Tops Markets
Brian Huckle, Director of Pharmacy
(716) 635-5275
Signed By Date
1/11/2013
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