Contract Pharmacy Details

CVS ALBANY, L.L.C.
CAH331316-00 COMMUNITY MEMORIAL HOSPITAL INC.

Covered Entity Details

Entity Name

COMMUNITY MEMORIAL HOSPITAL INC.

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH331316-00

Entity Address

150 BROAD ST
HAMILTON, NY 13346

Medicare Provider Number

331316

Participating Start Date

4/1/2015

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05015
139 EAST MAIN STREET
WATERVILLE, NY 13480

Pharmacy Comments

Contract Details

Approval Date

10/15/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/7/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Sean Fadale, President and CEO
(315) 824-6080

Contract Pharmacy Representative

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

Signed By Date

10/15/2019

340B Drug Pricing Program Database