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FILLMORE & FISHERS PHARMACY INC
SCH330096-00 JONES MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
JONES MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH330096-00
Entity Address
191 NORTH MAIN STREET
WELLSVILLE, NY 14895
Medicare Provider Number
330096
Participating Start Date
10/1/2011
Last Recertification Date
9/6/2016
Entity Termination Date
10/1/2017
Pharmacy Details
Pharmacy Name
FILLMORE & FISHERS PHARMACY INC
Pharmacy Address
138 N MAIN ST
WELLSVILLE, NY 14895
Pharmacy Comments
Contract Details
Approval Date
1/22/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2017
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Tracy Gates, Chief Financial Officer
(585) 596-4002
Contract Pharmacy Representative
Brian Loucks, Owner
(716) 307-3225
Signed By Date
1/22/2015
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