Covered Entity Details

DSH330180 SAMARITAN HOSPITAL (Active) - information as of 6/21/2025 10:40:22 PM

Main Details

Name

SAMARITAN HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330180

Medicare Provider Number

330180

Additional Details

Current Program Status

Active

Registration Date

10/10/2018

Participating Start Date

1/1/2019

Participating Approval Date

10/23/2018

Last Recertification Date

8/27/2024

Contacts

Authorizing Official

Samaritan Hospital of Troy NY
Lori Santos, CFO
(518) 525-5537

Primary Contact

Samaritan Hospital
Dario Pantano, Pharmacy Manager
(518) 271-3454

Addresses

Street Address

2215 BURDETT AVE
TROY, NY 12180

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Shipping Address 1

Samaritan Hospital St. Mary's Campus
1300 Massachusetts Ave
Troy, NY 12180

Shipping Address 2

Samaritan Hospital
2215 Burdett Ave
Troy, NY 12180

Shipping Address 3

Samaritan Hospital - Albany Memorial Campus
600 Northern Blvd
Albany, NY 12204

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/09/2024	07/01/2024		07/01/2024
Contract Detail	AETNA SPECIALTY PHARMACY, LLC	503 SUNPORT LN		ORLANDO	FL	32809-7874	04/12/2019	07/01/2019	02/18/2021	10/04/2021
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/12/2021	10/01/2021		10/05/2021
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/12/2021	10/01/2021		10/05/2021
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/12/2021	10/01/2021		10/05/2021
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/12/2021	10/01/2021		10/05/2021
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/12/2021	10/01/2021		10/05/2021
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/12/2021	10/01/2021		10/05/2021
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/12/2021	10/01/2021		10/05/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02743	485 COLUMBIA ST.	COHOES	NY	12047	10/23/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00441	259 SARATOGA RD.	GLENVILLE	NY	12302	10/23/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00415	750 NEW LOUDON RD.	LATHAM	NY	12110	10/23/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA CVS/PHARMACY # 724	560 N. GREENBUSH RD.	RENSSELAER	NY	12144	10/23/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05031	598 COLUMBIA TURNPIKE	EAST GREENBUSH	NY	12061	10/23/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05032	541 PAWLLING AVE. PAWLING S/C	TROY	NY	12180	10/23/2018	01/01/2019	06/15/2023	04/09/2024
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00344	49 FOURTH STREET	TROY	NY	12180	10/23/2018	01/01/2019	06/26/2024	07/12/2024
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02226	12 SOUTH CENTRAL AVENUE	MECHANICVILLE	NY	12118	10/23/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00996	1544 CRESCENT ROAD	CLIFTON PARK	NY	12065	10/23/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01895	2040 WESTERN AVENUE, ROUTE 155	ALBANY	NY	12203	10/23/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00417	885 CENTRAL AVE.	ALBANY	NY	12206	10/23/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02137	74 MAIN AVENUE	WYNANTSKILL	NY	12198	10/23/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00906	461 2ND AVE.	TROY	NY	12182	10/23/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05389	2535 STATE ROUTE 9	MALTA	NY	12020	10/23/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02702	465 SAND CREEK RD.	COLONIE	NY	12205	10/23/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05046	839 RTE 146	CLIFTON PARK	NY	12065	10/23/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05045	1630 CHRISLER AVENUE	SCHENECTADY	NY	12303	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	CVS/PHARMACY # 16809	26 CROSSING BLVD	CLIFTON PARK	NY	12065	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	CVS/PHARMACY # 16919	625 3RD AVE EXT	RENSSELAER	NY	12144	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00600	415-419 DELAWARE AVENUE	ALBANY	NY	12209	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05035	1204 EASTERN AVE	SCHENECTADY	NY	12308	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00134	16 NEW SCOTLAND AVE.	ALBANY	NY	12208	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01090	416 ROUTE 9W	GLENMONT	NY	12077	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 03379	653 RTE. 9	WILTON	NY	12831	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02072	120 LAKEHILL RD.	BURNT HILLS	NY	12027	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05456	2027 DOUBLEDAY AVE.	BALLSTON SPA	NY	12020	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00783	2982 ROUTE 9	VALATIE	NY	12184	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02340	2037 STATE STREET	SCHENECTADY	NY	12304	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00413	1026 MADISON AVENUE	ALBANY	NY	12208	04/12/2019	07/01/2019	09/26/2023	04/09/2024
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05385	241 MOHAWK AVE	SCOTIA	NY	12302	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00731	34 CONGRESS ST.	SARATOGA SPRINGS	NY	12866	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 04610	2801 GUILDERLAND AVE	ROTTERDAM	NY	12306	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05037	2480 US ROUTE 9W STE. 3 FAITH PLAZA	RAVENA	NY	12143	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00680	153 CENTRAL AVENUE	ALBANY	NY	12206	04/12/2019	07/01/2019	01/03/2023	02/15/2023
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05358	3916 CARMAN RD.	SCHENECTADY	NY	12303	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00375	260 DELAWARE AVENUE	DELMAR	NY	12054	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	CVS/PHARMACY # 17033	675 TROY SCHENECTADY RD	LATHAM	NY	12110	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05047	584 NEW LOUDON ROAD	LATHAM	NY	12110	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00744	613 NEW SCOTLAND AVENUE	ALBANY	NY	12208	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01292	1330 BALLTOWN ROAD	NISKAYUNA	NY	12309	04/12/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00778	1170 WESTERN AVENUE	ALBANY	NY	12203	01/10/2020	04/01/2020		04/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00451	415 STATE ST, WALLACE BLDG	SCHENECTADY	NY	12305	01/10/2020	04/01/2020	09/12/2024	10/15/2024
Contract Detail	CVS ALBANY, L.L.C.	CVS/PHARMACY # 16851	428 BALLTOWN RD	SCHENECTADY	NY	12304	01/10/2020	04/01/2020		04/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00419	216 QUAKER ROAD	QUEENSBURY	NY	12804	01/10/2020	04/01/2020		04/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00424	160 FAIRVIEW AVE. STE 20	HUDSON	NY	12534	01/10/2020	04/01/2020		04/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05036	7600 ROUTE 32, PO BOX 140	CAIRO	NY	12413	01/10/2020	04/01/2020		04/01/2020
Contract Detail	CVS ALBANY, L.L.C.	CVS/PHARMACY # 16615	1440 CENTRAL AVE	COLONIE	NY	12205	07/08/2020	10/01/2020		10/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05030	1475 WESTERN AVE. STUYVESANT PLAZA	ALBANY	NY	12203	07/08/2020	10/01/2020		10/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00793	1013 STATE HIGHWAY 29A	GLOVERSVILLE	NY	12078	07/08/2020	10/01/2020		10/01/2020
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/04/2021	01/01/2022		01/01/2022
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/04/2021	01/01/2022		01/01/2022
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/12/2021	10/01/2021		10/05/2021
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	10/23/2018	01/01/2019		01/01/2019
Contract Detail	ECKERD CORPORATION	RITE AID #10687	83 VANDENBURGH AVE	TROY	NY	12180-6024	10/23/2018	01/01/2019	06/11/2019	06/20/2019
Contract Detail	ECKERD CORPORATION	RITE AID #10680	1483 ROUTE 9	CLIFTON PARK	NY	12065	10/23/2018	01/01/2019	06/11/2019	06/20/2019
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/10/2020	04/01/2020	09/24/2020	09/30/2020
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	01/10/2020	04/01/2020	09/24/2020	09/30/2020
Contract Detail	PHARMACY ASSOC OF GLENS FALLS	OMNICARE OF BALLSTON SPA	14 COMMERCE DR	BALLSTON SPA	NY	12020-3631	07/13/2021	10/01/2021		10/05/2021
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	10/23/2018	01/01/2019	10/03/2022	10/04/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/12/2019	07/01/2019		07/01/2019
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/12/2021	10/01/2021		10/05/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/12/2021	10/01/2021		10/05/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/12/2021	10/01/2021		10/05/2021
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	01/18/2022	04/01/2022		04/01/2022
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #7829	1701 ROUTE 9	CLIFTON PARK	NY	12065	10/23/2018	01/01/2019	06/11/2019	06/20/2019
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4928	1863 CENTRAL AVENUE	COLONIE	NY	12205	10/23/2018	01/01/2019	06/11/2019	06/20/2019
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #1561	272 HOOSICK STREET	TROY	NY	12180	10/23/2018	01/01/2019	06/11/2019	06/20/2019
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	01/12/2022	04/01/2022		04/01/2022
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	01/12/2022	04/01/2022		04/01/2022
Contract Detail	TRINITY HEALTH PHARMACY SERVICES, LLC	12279 BLUFFTON RD		FORT WAYNE	IN	46809-3208	04/06/2022	07/01/2022		07/01/2022
Contract Detail	VERMONT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00337	8 KOCHER DR.	BENNINGTON	VT	05201	04/12/2019	07/01/2019		07/01/2019
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/03/2019	01/01/2020	06/20/2024	08/27/2024
Contract Detail	WAL-MART PHARMACY 10-1940	279 TROY RD		RENSSELAER	NY	12144	10/03/2019	01/01/2020	06/20/2024	08/27/2024
Contract Detail	WAL-MART PHARMACY 10-1997	800 LOUDON ROAD		LATHAM	NY	12110	10/03/2019	01/01/2020	06/20/2024	08/27/2024
Contract Detail	WAL-MART PHARMACY 10-2370	760 HOOSICK RD		TROY	NY	12180	10/03/2019	01/01/2020	06/20/2024	08/27/2024
Contract Detail	WAL-MART PHARMACY 10-2844	1549 ROUTE 9		HALFMOON	NY	12065	10/03/2019	01/01/2020	06/20/2024	08/27/2024
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/03/2019	01/01/2020	06/20/2024	08/27/2024
Contract Detail	WALGREEN EASTERN CO INC	DBA: WALGREENS #10548	549 HOOSICK ST.	TROY	NY	12180-2105	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC	DBA: WALGREENS #17856	4357 NY HIGHWAY 150 PO BOX 372	WEST SAND LAKE	NY	12196	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC	DBA: WALGREENS #17722	90 WEST AVE	SARATOGA SPRINGS	NY	12866-6003	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC	WALGREENS #19611	957 CURRY RD	ROTTERDAM	NY	12306-2909	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC	WALGREENS #19091	1203 EASTERN AVE	SCHENECTADY	NY	12308-3501	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC	DBA: WALGREENS #19732	4 MAIN ST	SCHAGHTICOKE	NY	12154	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC	DBA: WALGREENS #19948	1901 2ND AVE.	WATERVLIET	NY	12189-2211	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC	RITE AID #10696	1409 ALTAMONT	SCHENECTADY	NY	12303-2904	10/23/2018	01/01/2019	02/13/2019	11/11/2019
Contract Detail	WALGREEN EASTERN CO., INC	WALGREENS #19635	869 SECOND AVE.	TROY	NY	12182-1920	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC	WALGREENS # 19535	305 COLUMBIA ST.	RENSSELAER	NY	12144-2920	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC	RITE AID #04805	2463 US ROUTE 9W	RAVENA	NY	12143	10/23/2018	01/01/2019	11/04/2019	11/11/2019
Contract Detail	WALGREEN EASTERN CO., INC	WALGREENS #17264	1344 GERLING ST	SCHENECTADY	NY	12308-1702	10/23/2018	01/01/2019	08/19/2024	08/27/2024
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19462	41 PARK PLZ	MECHANICVILLE	NY	12118-1520	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	RITE AID #10692	911 CENTRAL AVE STE 10	ALBANY	NY	12206-1304	10/23/2018	01/01/2019	06/12/2019	06/20/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19764	22 MAIN ST	HOOSICK FALLS	NY	12090	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18016	212 MAIN ST	WILLIAMSTOWN	MA	01267	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #$ 19856	1645 COLUMBIA TPKE	CASTLETON	NY	12033	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	121 OLD ROUTE 146	HALFMOON	NY	12065	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	RITE AID #10699	1215 TROY SCHENECTADY RD	LATHAM	NY	12110-1011	10/23/2018	01/01/2019	02/11/2019	11/11/2019
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS # 19884	463 ALBANY SHAKER RD	LOUDONVILLE	NY	12211-1833	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19882	27 ROUND LAKE RD	BALLSTON LAKE	NY	12019-1129	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19988	17 N PEARL ST	ALBANY	NY	12207	10/23/2018	01/01/2019	02/18/2021	02/19/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18207	2 NORTH PARK ST	CAMBRIDGE	NY	12816-1105	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #21158	33 NEW SCOTLAND AVE STE 106	ALBANY	NY	12208	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	RITE AID #00784	1022 ROUTE 146	CLIFTON PARK	NY	12065-3618	10/23/2018	01/01/2019	05/20/2019	06/03/2019
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17434	614 COLUMBIA TPKE	EAST GREENBUSH	NY	12061-1610	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	1476 ROUTE 9	HALFMOON	NY	12065-6524	10/23/2018	01/01/2019	03/03/2020	03/09/2020
Contract Detail	WALGREEN EASTERN CO., INC.	RITE AID #03331	308 ONTARIO ST	COHOES	NY	12047	10/23/2018	01/01/2019	05/21/2019	06/03/2019
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18158	581 CENTRAL AVE	ALBANY	NY	12206	10/23/2018	01/01/2019	06/03/2020	06/15/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09154	1850 CENTRAL AVE	COLONIE	NY	12205	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19787	933 LOUDON RD	LATHAM	NY	12110-2119	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18141	444 BROADWAY STE 1	MENANDS	NY	12204-2852	10/23/2018	01/01/2019	02/18/2021	02/24/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18978	15 COLEMAN STREET	CHATHAM	NY	12037	01/09/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS	41 HOLLAND AVE.	ALBANY	NY	12208	04/21/2025	07/01/2025		04/21/2025
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18980	5 GARLAND LN	GREENVILLE	NY	12083-3410	04/21/2025	07/01/2025		04/21/2025
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	10/23/2018	01/01/2019	10/01/2021	10/04/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/23/2018	01/01/2019		01/01/2019
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/07/2023	10/01/2023	06/20/2024	08/27/2024
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/12/2023	01/01/2024	06/20/2024	08/27/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330180A	Child	DSH	SAMARITAN HOSPITAL	ST PETERS URGENT CARE - Urgent Care	79 VANDENBURGH AVE	TROY	NY	Terminated
DSH330180AA	Child	DSH	SAMARITAN HOSPITAL	St. Peter's Urgent Care - Troy - Urgent Care	1300 Massachusettes Ave	Troy	NY	Terminated
DSH330180AB	Child	DSH	SAMARITAN HOSPITAL	Hildegard Medicus Cancer Center - Radiation Oncology	1300 Massachusettes Ave	Troy	NY	Terminated
DSH330180AC	Child	DSH	SAMARITAN HOSPITAL	St. Mary's Endoscopy Center - Endoscopy	1300 Massachusettes Ave	Troy	NY	Terminated
DSH330180AD	Child	DSH	SAMARITAN HOSPITAL	Hildegard Medicus Cancer Center - Medical Oncology	1300 Massachusettes Ave	Troy	NY	Active
DSH330180AE	Child	DSH	SAMARITAN HOSPITAL	Troy Internal Medicine - Primary Care	1401 Massachusettes Ave	Troy	NY	Active
DSH330180AF	Child	DSH	SAMARITAN HOSPITAL	Wound Care and Hyperbaric Program - Wound Care	147 Hoosick St	Troy	NY	Terminated
DSH330180AG	Child	DSH	SAMARITAN HOSPITAL	Incontinence Treatment Center - Incontinence Treatment	147 Hoosick St	Troy	NY	Terminated
DSH330180AH	Child	DSH	SAMARITAN HOSPITAL	Anticoagulation Clinic - Troy - Anticoagulation Clinic	147 Hoosick St	Troy	NY	Active
DSH330180AJ	Child	DSH	SAMARITAN HOSPITAL	Capital Region Family Health Center - Primary Care	2 Empire Dr	Rensselaer	NY	Active
DSH330180AK	Child	DSH	SAMARITAN HOSPITAL	St. Peter's Urgent Care - East Greenbush - Urgent Care	2 Empire Dr	Rensselaer	NY	Terminated
DSH330180AL	Child	DSH	SAMARITAN HOSPITAL	Samaritan OBGYN - East Greenbush - OB/GYN	2 Empire Drive	Rensselaer	NY	Active
DSH330180AM	Child	DSH	SAMARITAN HOSPITAL	Samaritan OB/GYN - Troy - OB/GYN	2231 Burdett Ave	Troy	NY	Active
DSH330180AN	Child	DSH	SAMARITAN HOSPITAL	Troy Pediatric Health Center - Pediatrics	1300 Massachusetts Ave	Troy	NY	Active
DSH330180AP	Child	DSH	SAMARITAN HOSPITAL	Samaritan OBGYN - Cohoes - OB/GYN	55 Mohawk St	Cohoes	NY	Terminated
DSH330180AQ	Child	DSH	SAMARITAN HOSPITAL	Samaritan OBGYN - Latham - OB/GYN	713 Troy-Schenectady Road	Latham	NY	Active
DSH330180AR	Child	DSH	SAMARITAN HOSPITAL	Samaritan OBGYN - Clifton Park - OB/GYN	855 Rt 146	Clifton Park	NY	Active
DSH330180AS	Child	DSH	SAMARITAN HOSPITAL	St. Peter's Internal Medicine - Primary Care	147 Hoosick St	Troy	NY	Active
DSH330180AT	Child	DSH	SAMARITAN HOSPITAL	Clifton Park Family Practice - family practice	1 Tallow Wood Drive	Clifton Park	NY	Active
DSH330180AU	Child	DSH	SAMARITAN HOSPITAL	Stillwater Family Health Center - Primary Care	1111 Hudson Ave	Stillwater	NY	Active
DSH330180AV	Child	DSH	SAMARITAN HOSPITAL	ST. PETER'S PELVIC HEALTH CENTER - Pelvic Health	600 NORTHERN BLVD 3RD FLOOR	ALBANY	NY	Active
DSH330180AW	Child	DSH	SAMARITAN HOSPITAL	St. Peter's Health Partners Infusion Center - AMH Campus - Infusion Services	600 Northern Blvd 4th floor	Albany	NY	Active
DSH330180AX	Child	DSH	SAMARITAN HOSPITAL	Anticoagulation Clinic - AMH Campus - Anticoagulation Clinic	600 Northern Blvd 1st Floor	Albany	NY	Active
DSH330180AY	Child	DSH	SAMARITAN HOSPITAL	INTERNAL MEDICINE ASSOCIATES - Internal Medicine	63 SHAKER ROAD SUITE G02	ALBANY	NY	Active
DSH330180AZ	Child	DSH	SAMARITAN HOSPITAL	St. Peter's Health Partners Outpatient Wound Care - Wound Care	600 Northern Blvd 6th Floor	Albany	NY	Active
DSH330180B	Child	DSH	SAMARITAN HOSPITAL	MENTAL HEALTH PROS CLINIC - Behavioral Health	1801 6th Ave	Troy	NY	Active
DSH330180BA	Child	DSH	SAMARITAN HOSPITAL	Troy Surgery Associates - Surgery Services	1 Tallow Wood Dr.	Clifton Park	NY	Terminated
DSH330180BB	Child	DSH	SAMARITAN HOSPITAL	CAPITAL DISTRICT INTERNAL MEDICINE - Internal Medicine	1440 WESTERN AVENUE	ALBANY	NY	Terminated
DSH330180BC	Child	DSH	SAMARITAN HOSPITAL	Emergency Department - AMH Campus - Emergency Department	600 Northern Blvd 1st Floor	Albany	NY	Active
DSH330180C	Child	DSH	SAMARITAN HOSPITAL	ST PETER'S DIABETES & ENDOCRINE CARE - Endocrinology	279 Troy Rd	Rensselaer	NY	Terminated
DSH330180D	Child	DSH	SAMARITAN HOSPITAL	COHOES FAMILY CARE - Family Medicine	55 MOHAWK ST	COHOES	NY	Active
DSH330180E	Child	DSH	SAMARITAN HOSPITAL	TROY INFECTIOUS DISEASE - Infectious Disease	Samaritan Medical Arts Building	Troy	NY	Terminated
DSH330180F	Child	DSH	SAMARITAN HOSPITAL	SPECIALTY SURGEONS - Thoracic and Esophageal	Samaritan Medical Arts Building	Troy	NY	Terminated
DSH330180G	Child	DSH	SAMARITAN HOSPITAL	ST PETER'S DIABETES & ENDOCRINE CARE - Endocrinology	55 Mohawk St	Cohoes	NY	Terminated
DSH330180H	Child	DSH	SAMARITAN HOSPITAL	TROY SURGICAL ASSOCIATES - Surgery	Samaritan Medical Arts Building	Troy	NY	Active
DSH330180J	Child	DSH	SAMARITAN HOSPITAL	RVERSIDE ORTHOPEDICS - Orthopedic Surgery	35 Lower Hudson Ave	Green Island	NY	Terminated
DSH330180K	Child	DSH	SAMARITAN HOSPITAL	ST PETER'S DIABETES & ENDOCRINE CARE - Endocrinology	158 Saratoga Ave	Waterford	NY	Terminated
DSH330180L	Child	DSH	SAMARITAN HOSPITAL	RIVERSIDE ORTHOPEDICS - Orthopedic Surgery	279 Troy Rd	Rensselaer	NY	Terminated
DSH330180M	Child	DSH	SAMARITAN HOSPITAL	TROY FAMILY HEALTH CENTER - Family Medicine	79 VANDENBURGH AVE	TROY	NY	Active
DSH330180N	Child	DSH	SAMARITAN HOSPITAL	FAMILY MEDICAL GROUP - Family Medicine	279 Troy Rd	Rensselaer	NY	Active
DSH330180P	Child	DSH	SAMARITAN HOSPITAL	WATERFORD HEALTH CENTER - Internal Medicine	158 SARATOGA AVE	WATERFORD	NY	Active
DSH330180Q	Child	DSH	SAMARITAN HOSPITAL	RIVERSIDE MEDICAL CENTER - Family Medicine	35 LOWER HUDSON AVE	GREEN ISLAND	NY	Active
DSH330180R	Child	DSH	SAMARITAN HOSPITAL	TROY UROLOGICAL ASSOCIATES - Urology	Samaritan Medical Arts Building	Troy	NY	Terminated
DSH330180S	Child	DSH	SAMARITAN HOSPITAL	MENTAL HEALTH SATELITE CLINIC - Behavioral Health	1801 6th Ave	Troy	NY	Terminated
DSH330180T	Child	DSH	SAMARITAN HOSPITAL	Latham Primary Care Associates - Primary Care	1 Bell Tower Drive	Watervliet	NY	Active
DSH330180U	Child	DSH	SAMARITAN HOSPITAL	Clifton Park Urgent Care - Urgent Care	1 Tallow Wood Drive	Clifton Park	NY	Terminated
DSH330180V	Child	DSH	SAMARITAN HOSPITAL	Clifton Park Pediatrics - Pediatrics	1 Tallow Wood Drive	Clifton Park	NY	Active
DSH330180W	Child	DSH	SAMARITAN HOSPITAL	Anticoagulation Clinic - Clifton Park - Anticoagulation Clinic	1 Tallow Wood Drive	Clifton Park	NY	Active
DSH330180X	Child	DSH	SAMARITAN HOSPITAL	St. Mary's Outpatient Detoxification - Detoxification	1300 Massachusettes Ave	Troy	NY	Terminated
DSH330180Y	Child	DSH	SAMARITAN HOSPITAL	St. Mary's Sleep Center - Sleep Center	1300 Massachusettes Ave	Troy	NY	Active
DSH330180Z	Child	DSH	SAMARITAN HOSPITAL	Hildegard Medicus Cancer Center - Infusion Center	1300 Massachusettes Ave	Troy	NY	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/12/2023 1:55:17 PM	8/27/2024 10:44:25 AM	8/27/2024 10:44 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 7:02:08 AM	9/12/2023 1:55:17 PM	9/12/2023 1:55 PM
Details	Last Recertification Date	Update	Recertification	8/26/2021 8:38:40 AM	8/29/2022 7:02:08 AM	8/29/2022 7:02 AM
Details	Last Recertification Date	Update	Recertification	8/24/2020 3:36:57 PM	8/26/2021 8:38:40 AM	8/26/2021 8:38 AM
Contacts	Primary Contact	Update	Change Request	KENNICUTT, JEANNE MGR AMBULATORY CARE PHARMACY SERVICES Samaritan Hospital of Troy NY 5185256132	Pantano, Dario Pharmacy Manager Samaritan Hospital 5182713454	4/28/2021 8:51 PM
Details	Last Recertification Date	Update	Recertification	8/28/2019 8:44:52 PM	8/24/2020 3:36:57 PM	8/24/2020 3:36 PM
Addresses	Shipping Address	Insert	Change Request		Samaritan Hospital - Albany Memorial Campus 600 Northern Blvd Albany, NY 12204	7/21/2020 8:25 AM
Contacts	Authorizing Official	Update	Profile Change Request	Santos, Lori CFO Seton-St. Mary's 5185253357	Santos, Lori CFO Samaritan Hospital of Troy NY 5185255537	11/11/2019 2:42 PM
Contacts	Signed By	Update	Profile Change Request	Santos, Lori CFO Seton-St. Mary's 5185253357	Santos, Lori CFO Samaritan Hospital of Troy NY 5185255537	11/11/2019 2:42 PM
Contacts	Primary Contact	Update	Profile Change Request	KENNICUTT, JEANNE MGR AMBULATORY CARE PHARMACY SERVICES Seton Health, St. Mary's Hospital 5185256132	KENNICUTT, JEANNE MGR AMBULATORY CARE PHARMACY SERVICES Samaritan Hospital of Troy NY 5185256132	11/8/2019 10:36 AM
Details	Last Recertification Date	Update	Recertification		8/28/2019 8:44:52 PM	8/28/2019 8:44 PM
Addresses	Shipping Address	Insert	Change Request		Samaritan Hospital St. Mary's Campus 1300 Massachusetts Ave Troy, NY 12180	3/29/2019 1:34 PM
Addresses	Shipping Address	Insert	Change Request		Samaritan Hospital 2215 Burdett Ave Troy, NY 12180	3/29/2019 1:34 PM
Details	State	Update		Approved	Active	1/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Santos, Lori CFO Seton-St. Mary's 5185253357	10/23/2018 1:14 PM
Details	340B ID	Update	New Registration		DSH330180	10/23/2018 1:14 PM
Dates	Participating Approval Date	Update	New Registration		10/23/2018 1:14:37 PM	10/23/2018 1:14 PM
Details	State	Update	New Registration	Pending	Approved	10/23/2018 1:14 PM
Dates	Signed By Date	Update	New Registration		10/12/2018 8:43:21 PM	10/23/2018 1:14 PM
Dates	Start Date	Update	New Registration		1/1/2019 12:00:00 AM	10/23/2018 1:14 PM
Addresses	Main Address	Insert	New Registration		2215 BURDETT AVE TROY, NY 12180	10/10/2018 11:26 AM
Contacts	Primary Contact	Insert	New Registration		KENNICUTT, JEANNE MGR AMBULATORY CARE PHARMACY SERVICES Seton Health, St. Mary's Hospital 5185256132	10/10/2018 11:26 AM
Contacts	Authorizing Official	Insert	New Registration		Santos, Lori CFO Seton-St. Mary's 5185253357	10/10/2018 11:26 AM
Details	Last Recertification Date	Insert	New Registration			10/10/2018 11:26 AM
Details	Grant Number	Insert	New Registration			10/10/2018 11:26 AM
Details	340B ID	Insert	New Registration			10/10/2018 11:26 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/10/2018 11:26 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/10/2018 11:26 AM
Details	Medicare Provider Number	Insert	New Registration		330180	10/10/2018 11:26 AM
Details	Entity Name	Insert	New Registration		SAMARITAN HOSPITAL	10/10/2018 11:26 AM
Details	Program Code	Insert	New Registration		DSH	10/10/2018 11:26 AM
Details	Entity Subname	Insert	New Registration			10/10/2018 11:26 AM
Dates	Participating Approval Date	Insert	New Registration			10/10/2018 11:26 AM
Details	State	Insert	New Registration		Pending	10/10/2018 11:26 AM
Dates	Registration Date	Insert	New Registration		10/10/2018 11:26:09 AM	10/10/2018 11:26 AM
Dates	Signed By Date	Insert	New Registration			10/10/2018 11:26 AM
Dates	Start Date	Insert	New Registration			10/10/2018 11:26 AM
Terminations	Termination Comments	Insert	New Registration			10/10/2018 11:26 AM
Terminations	Termination Date	Insert	New Registration			10/10/2018 11:26 AM
Terminations	Termination Effective Date	Insert	New Registration			10/10/2018 11:26 AM
Terminations	Termination Reason	Insert	New Registration			10/10/2018 11:26 AM