Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330396 WOODHULL HOSPITAL CENTER

Covered Entity Details

Entity Name

WOODHULL HOSPITAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330396

Entity Address

760 BROADWAY
MAIN ENTRANCE: 720 FLUSHING AV
BROOKLYN, NY 11206

Medicare Provider Number

330396

Participating Start Date

12/1/1992

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02699
411 DITMAS AVENUE
BROOKLYN, NY 11218

Pharmacy Comments

Contract Details

Approval Date

7/8/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/2/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Paul Albertson, Vice President
(212) 748-2256

Contract Pharmacy Representative

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

Signed By Date

7/8/2019

340B Drug Pricing Program Database