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WEGMANS FOOD MARKETS, INC.
DSH330188 Mount St. Mary's Hospital and Health Center
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Covered Entity Details
Entity Name
Mount St. Mary's Hospital and Health Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330188
Entity Address
5300 MILITARY ROAD
LEWISTON, NY 14092
Medicare Provider Number
330188
Participating Start Date
1/1/2014
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WEGMANS FOOD MARKETS, INC.
Pharmacy Address
675 ALBERTA DRIVE
ATTN: PHARMACY
AMHERST, NY 14226
Pharmacy Comments
Contract Details
Approval Date
4/18/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
GARY TUCKER, PRESIDENT/CEO
(716) 298-2004
Contract Pharmacy Representative
Pharmacy Business Relations Mgr
Brian Pompo, Pharmacy Business Relations Manager
(315) 546-1100 Ext: 431
Signed By Date
4/18/2016
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