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WAL-MART PHARMACY 10-2874
RW4248550 The Albany Damien Center Inc.
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Covered Entity Details
Entity Name
The Albany Damien Center Inc.
Subdivision Name
Type
Ryan White Part D
340B ID
RW4248550
Entity Address
728 Madison Ave
Suite 100
Albany, NY 12208-3302
Grant Number
H12HA24855
Participating Start Date
1/1/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2874
Pharmacy Address
200 DUTCH MEADOWS LANE
GLENVILLE, NY 12302
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/28/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Perry Junjulas, Executive Director
(518) 449-7119 Ext: 102
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/15/2020
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