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FILLMORE & FISHER PHCY
DSH330096 JONES MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
JONES MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330096
Entity Address
191 North Main Street
WELLSVILLE, NY 14895-0072
Medicare Provider Number
330096
Participating Start Date
10/1/2017
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
FILLMORE & FISHER PHCY
Pharmacy Address
DBA CUBA PHARMACY
2 CENTER ST
CUBA, NY 14727
Pharmacy Comments
Contract Details
Approval Date
8/10/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James Helms, Vice President of Finance
(585) 596-4002
Contract Pharmacy Representative
Brian Loucks, Owner
(716) 307-3225
Signed By Date
8/10/2017
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