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CVS ALBANY, L.L.C.
DSH330044 MVHS, Inc. DBA: Wynn Hospital
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Covered Entity Details
Entity Name
MVHS, Inc. DBA: Wynn Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330044
Entity Address
111 Hospital Drive
Utica, NY 13502
Medicare Provider Number
330044
Participating Start Date
7/1/2014
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05027
625 E. MAIN ST.
LITTLE FALLS, NY 13365
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Louis Aiello, Sr. VP Finance/ CFO
(315) 917-8213
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2019
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