Contract Pharmacy Details

ECKERD CORPORATION
DSH330250 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL

Covered Entity Details

Entity Name

CHAMPLAIN VALLEY PHYSICIANS HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330250

Entity Address

75 BEEKMAN STREET
PLATTSBURGH, NY 12901

Medicare Provider Number

330250

Participating Start Date

6/3/2019

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

ECKERD CORPORATION

Pharmacy Address

RITE AID #10723
357 CORNELIA STREET
PLATTSBURGH, NY 12901

Pharmacy Comments

Contract Details

Approval Date

9/15/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/6/2018
Ownership change

Contacts

Covered Entity Signing Official

JOYCE RAFFERTY, VICE PRESIDENT OF FINANCE
(518) 562-7047

Contract Pharmacy Representative

Rite Aid Corp.
Wendy Barnes, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

9/15/2014

340B Drug Pricing Program Database