Contract Pharmacy Details

SAINT VINCENT HEALTH CENTER
DSH390009 SAINT VINCENT HEALTH CENTER

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

SAINT VINCENT HEALTH CENTER

Pharmacy Address

PHARMACY
232 W 25TH ST
ERIE, PA 16544

Pharmacy Comments

Contract Details

Approval Date

7/27/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2017
Agreement registered in error

Contacts

Covered Entity Signing Official

CHRISTOPHER C. CLARK, PRESIDENT
(814) 452-5111

Contract Pharmacy Representative

Saint Vincent Health Center
PETER PASCALE, 340B ADMINISTRATOR
(814) 450-3613

Signed By Date

7/27/2017

340B Drug Pricing Program Database