340B Drug Pricing Program Database
CVS ALBANY, L.L.C.
DSH330073 UNITED MEMORIAL MEDICAL CENTER - information as of 4/24/2025 11:31:32 PM
Covered Entity Details
Entity Name
UNITED MEMORIAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330073
Entity Address
127 NORTH STREET
BATAVIA, NY 14020
Medicare Provider Number
330073
Participating Start Date
1/1/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00575
259 WEST MAIN ST.,
BATAVIA, NY 14020
Pharmacy Comments
Contract Details
Approval Date
4/12/2013
Contract Begin Date
4/12/2013
Carve-In Effective Date
Contract Comments
04/12/2013 - public health emergency declared in the state of NY effective 10/27/2012
Contract Termination Date
Termination Reason
3/27/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert L. Chiavetta, CFO
(585) 344-5249
Contract Pharmacy Representative
CVS
Scott Tierney, Senior Director, Payer Relations
(401) 770-2762
Signed By Date
4/12/2013
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