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WEGMANS FOOD MARKETS, INC.
DSH330265 Clifton Springs Hospital
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Covered Entity Details
Entity Name
Clifton Springs Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330265
Entity Address
2 Coulter Road
Clifton Springs, NY 14432
Medicare Provider Number
330265
Participating Start Date
7/1/2012
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WEGMANS FOOD MARKETS, INC.
Pharmacy Address
C/O PHARMACY
800 W MILLER ST
NEWARK, NY 14513-1354
Pharmacy Comments
02/06/2012 changed store # (was 106)
Contract Details
Approval Date
7/25/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donna Smith, VP of Operations
(315) 462-0100
Contract Pharmacy Representative
Pharmacy Business Relations Mgr
Brian Pompo, Pharmacy Business Relations Manager
(315) 546-1100 Ext: 431
Signed By Date
7/25/2016
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