Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
SCH330223-05 MASSENA HOSPITAL, INC.

Covered Entity Details

Entity Name

MASSENA HOSPITAL, INC.

Subdivision Name

MMH OB/GYN

Type

Sole Community Hospital

340B ID

SCH330223-05

Entity Address

15 HOSPITAL DR
MASSENA, NY 13662

Medicare Provider Number

330223

Outpatient Facility Provider Number

Participating Start Date

4/1/2017

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS # 10293
173 MARKET ST
POTSDAM, NY 13676-1221

Pharmacy Comments

Contract Details

Approval Date

3/24/2017

Contract Begin Date

4/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2017
Agreement registered in error

Contacts

Covered Entity Signing Official

Patrick Facteau, CFO
(315) 769-4207

Contract Pharmacy Representative

CHARLES DAVIS, 340 B, PHARMACIST
(315) 265-6291

Signed By Date

3/24/2017

340B Drug Pricing Program Database