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ALBANY MEDICAL CENTER HOSPITAL
DSH330013F ALBANY MEDICAL CENTER HOSPITAL
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Covered Entity Details
Entity Name
ALBANY MEDICAL CENTER HOSPITAL
Subdivision Name
AMCH Urology Clinic - Urology
Type
Disproportionate Share Hospital
340B ID
DSH330013F
Entity Address
23 Hackett Blvd
Albany, NY 12208
Medicare Provider Number
330013
Outpatient Facility Provider Number
Participating Start Date
1/1/2019
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
ALBANY MEDICAL CENTER HOSPITAL
Pharmacy Address
PHARMACY DEPARTMENT
43 NEW SCOTLAND AVE
ALBANY, NY 12208-3412
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
FERDINAND J. VENDITTI, EXECUTIVE VP FOR SYSTEM CARE DELIVERY
(518) 262-5376
Contract Pharmacy Representative
Albany Medical Center Hospital
anthony dispirito, Director Pharmacy Services
(518) 262-3255
Signed By Date
7/12/2019
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