Contract Pharmacy Details

SCHELL'S PHARMACY
DSH330047 ST. MARYS HEALTHCARE

Covered Entity Details

Entity Name

ST. MARYS HEALTHCARE

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330047

Entity Address

427 GUY PARK AVENUE
AMSTERDAM, NY 12010

Medicare Provider Number

330047

Participating Start Date

10/1/2009

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

SCHELL'S PHARMACY

Pharmacy Address

179 EAST MAIN STREET
AMSTERDAM, NY 12010-4818

Pharmacy Comments

Contract Details

Approval Date

1/16/2017

Contract Begin Date

4/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2018
Pharmacy closed

Contacts

Covered Entity Signing Official

Keith Waters, Sr. Director Of Finance
(518) 770-7583

Contract Pharmacy Representative

John Rakstis, President
(518) 842-5460

Signed By Date

1/16/2017