Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330180 SAMARITAN HOSPITAL

Covered Entity Details

Entity Name

SAMARITAN HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330180

Entity Address

2215 BURDETT AVE
TROY, NY 12180

Medicare Provider Number

330180

Participating Start Date

1/1/2019

Last Recertification Date

8/27/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00134
16 NEW SCOTLAND AVE.
ALBANY, NY 12208

Pharmacy Comments

Contract Details

Approval Date

4/12/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Lori Santos, CFO
(518) 525-5537

Contract Pharmacy Representative

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

Signed By Date

4/12/2019

340B Drug Pricing Program Database