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CVS ALBANY, L.L.C.
RRC330103-00 Olean General Hospital
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Covered Entity Details
Entity Name
Olean General Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC330103-00
Entity Address
515 Main Street
Olean, NY 14760
Medicare Provider Number
330103
Participating Start Date
4/1/2014
Last Recertification Date
8/23/2018
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05087
19 S. MAIN ST.
JAMESTOWN, NY 14701
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Richard G. Braun Jr., SVP Finance and CFO
(716) 375-6190
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2018
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