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MARKS, JEFFREY A.
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
MARKS, JEFFREY A.
Pharmacy Address
DBA: FRIENDSHIP PHARMACY
9 WEST MAIN ST.
PO BOX 128
FRIENDSHIP, NY 14739
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
5/31/2023
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
Jeff Marks, Owner/PIC
(585) 973-3496
Signed By Date
8/10/2017
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