Contract Pharmacy Details

CVS ALBANY, L.L.C.
CH021500 MOUNT VERNON NEIGHBORHOOD HEALTH CENTER, INC.

Covered Entity Details

Entity Name

MOUNT VERNON NEIGHBORHOOD HEALTH CENTER, INC.

Subdivision Name

MOUNT VERNON NEIGHBORHOOD HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH021500

Entity Address

107 W 4th St
Mount Vernon, NY 10550-4002

Grant Number

H80CS00161

Participating Start Date

9/9/2005

Last Recertification Date

2/25/2025

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02164
211 EAST SANDFORD BLVD.
MOUNT VERNON, NY 10550

Pharmacy Comments

Contract Details

Approval Date

1/2/2020

Contract Begin Date

1/2/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Judith Watson, CEO
(914) 699-7200

Contract Pharmacy Representative

CVS Health
John Carlson, Director, Health System Alliances
(781) 559-9636

Signed By Date

1/2/2020

340B Drug Pricing Program Database