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TEJHARSH INC
DSH330047 ST. MARYS HEALTHCARE
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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
TEJHARSH INC
Pharmacy Address
DBA: RIVERFRONT PHARMACY
2490 RIVERFRONT CTR
AMSTERDAM, NY 12010
Pharmacy Comments
Contract Details
Approval Date
4/4/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2021
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
Tejal Patel, President
(518) 843-0500
Signed By Date
4/4/2017
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