340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-1806
DSH330047 ST. MARYS HEALTHCARE
Print
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
WAL-MART PHARMACY 10-1806
Pharmacy Address
329 SOUTH KINGSBORO AVE.
GLOVERSVILLE, NY 12078
Pharmacy Comments
02/04/2013 city update (was JOHNSTOWN)
Contract Details
Approval Date
1/17/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/2/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Keith Waters, Sr. Director Of Finance
(518) 770-7583
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/17/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session