Contract Pharmacy Details

CVS ALBANY, L.L.C.
CH021887S SUNSET PARK HEALTH COUNCIL, INC.

Covered Entity Details

Entity Name

SUNSET PARK HEALTH COUNCIL, INC.

Subdivision Name

Callen-Lorde Community Health Center Mobile Primary Care Unit

Type

HRSA-Funded Health Center

340B ID

CH021887S

Entity Address

356 W 18th St
New York, NY 10011-4401

Grant Number

H80CS07914

Participating Start Date

10/1/2014

Last Recertification Date

2/21/2020

Entity Termination Date

1/1/2021

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

CVS/PHARMACY # 2280
329-339 WYCKOFF AVE
RIDGEWOOD, NY 11385

Pharmacy Comments

Contract Details

Approval Date

1/14/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/7/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Larry K. McReynolds, Executive Director
(718) 630-7216

Contract Pharmacy Representative

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

Signed By Date

1/14/2020

340B Drug Pricing Program Database