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WEGMANS FOOD MARKETS, INC.
SCH330151-00 ST. JAMES MERCY HOSPITAL
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Covered Entity Details
Entity Name
ST. JAMES MERCY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH330151-00
Entity Address
411 CANISTEO STREET
HORNELL, NY 14843
Medicare Provider Number
330151
Participating Start Date
1/1/2011
Last Recertification Date
8/24/2018
Entity Termination Date
1/1/2019
Pharmacy Details
Pharmacy Name
WEGMANS FOOD MARKETS, INC.
Pharmacy Address
1000 HIGHWAY 36 NORTH
ATTN: PHARMACY
HORNELL, NY 14843
Pharmacy Comments
01/25/2013 name update, DEA normalization (was Wegmans Pharmacy #017)
Contract Details
Approval Date
1/25/2013
Contract Begin Date
1/25/2013
Carve-In Effective Date
Contract Comments
01/25/2013 - public health emergency declared in the state of NY effective 10/27/2012
Contract Termination Date
Termination Reason
7/15/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mary E. LaRowe, President and CEO
(607) 324-8113
Contract Pharmacy Representative
Pharmacy Business Relations Mgr
Brian Pompo, Pharmacy Business Relations Manager
(315) 546-1100 Ext: 431
Signed By Date
1/25/2013
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