Contract Pharmacy Details

RITE AID OF NEW YORK, INC.
CH020870 NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC

Covered Entity Details

Entity Name

NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC

Subdivision Name

NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.

Type

HRSA-Funded Health Center

340B ID

CH020870

Entity Address

61 Delano St
Pulaski, NY 13142-1400

Grant Number

H80CS00166

Participating Start Date

10/1/2004

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #4457
110 EAST BROADWAY
FULTON, NY 13069

Pharmacy Comments

Contract Details

Approval Date

2/21/2018

Contract Begin Date

2/21/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/15/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Tracy L Wimmer, VP/Chief Financial Officer
(315) 298-6569 Ext: 2020

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

2/21/2018

340B Drug Pricing Program Database