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ECKERD CORPORATION
CH02179R HUDSON HEADWATERS HEALTH NETWORK
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Covered Entity Details
Entity Name
HUDSON HEADWATERS HEALTH NETWORK
Subdivision Name
Champlain Family Health
Type
HRSA-Funded Health Center
340B ID
CH02179R
Entity Address
828 State Route 11
Champlain, NY 12919-4819
Grant Number
H80CS00159
Participating Start Date
10/1/2012
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
ECKERD CORPORATION
Pharmacy Address
RITE AID #10723
357 CORNELIA STREET
PLATTSBURGH, NY 12901
Pharmacy Comments
Contract Details
Approval Date
9/26/2012
Contract Begin Date
10/1/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/8/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
George Purdue, Chief Administrative Officer
(518) 761-0300 Ext: 31114
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
9/11/2012
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