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WAL-MART PHARMACY 10-1926
SCH330218-00 Oswego Hospital
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Covered Entity Details
Entity Name
Oswego Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH330218-00
Entity Address
110 West 6th Street
Oswego, NY 13126
Medicare Provider Number
330218
Participating Start Date
12/2/2011
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1926
Pharmacy Address
341 ROUTE 104 EAST
OSWEGO, NY 13126
Pharmacy Comments
Contract Details
Approval Date
1/13/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert T. Pompo, Executive VP-Finance
(315) 349-5695
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/13/2016
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