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CVS ALBANY, L.L.C.
CH02152G OPEN DOOR FAMILY MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
OPEN DOOR FAMILY MEDICAL CENTER, INC.
Subdivision Name
OPEN DOOR MT. KISCO CLINIC
Type
HRSA-Funded Health Center
340B ID
CH02152G
Entity Address
30 W MAIN ST
MOUNT KISCO, NY 10549-1910
Grant Number
H80CS00160
Participating Start Date
11/25/2005
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01997
10 S. BEDFORD RD.
MOUNT KISCO, NY 10549
Pharmacy Comments
Contract Details
Approval Date
1/16/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/12/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lindsay Farrell, President and CEO
(914) 502-1450
Contract Pharmacy Representative
CVS
John Carlson, Director
(781) 559-9636
Signed By Date
1/16/2020
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