Contract Pharmacy Details

CVS ALBANY, L.L.C.
RWII12203 The Albany Damien Center, Inc.

Covered Entity Details

Entity Name

The Albany Damien Center, Inc.

Subdivision Name

Type

Ryan White Part B

340B ID

RWII12203

Entity Address

728 Madison Ave, Ste 100
Albany, NY 12208-3302

Grant Number

X07HA00044

Participating Start Date

10/1/2015

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00778
1170 WESTERN AVENUE
ALBANY, NY 12203

Pharmacy Comments

Contract Details

Approval Date

1/8/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Perry Junjulas, Executive Director
(518) 449-7119 Ext: 102

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/8/2019

340B Drug Pricing Program Database