Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330153 Ellis Hospital

Covered Entity Details

Entity Name

Ellis Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330153

Entity Address

1101 Nott Street
Schenectady, NY 12308

Medicare Provider Number

330153

Participating Start Date

7/1/2012

Last Recertification Date

8/23/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01895
2040 WESTERN AVENUE, ROUTE 155
ALBANY, NY 12203

Pharmacy Comments

Contract Details

Approval Date

7/15/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Marc Mesick, CFO & VP of Finance
(518) 243-4144

Contract Pharmacy Representative

CVS Health
Christian Reid, 340B Program Director
(401) 770-2118

Signed By Date

7/15/2019

340B Drug Pricing Program Database