Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330104 MONTEFIORE NYACK HOSPITAL

Covered Entity Details

Entity Name

MONTEFIORE NYACK HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330104

Entity Address

160 NORTH MIDLAND AVENUE
NYACK, NY 10960

Medicare Provider Number

330104

Participating Start Date

4/1/2006

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02205
274 OLD NYACK TURNPIKE
SPRING VALLEY, NY 10977

Pharmacy Comments

Contract Details

Approval Date

4/3/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/15/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

John S. Burke, CFO
(845) 348-2107

Contract Pharmacy Representative

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

Signed By Date

4/3/2020

340B Drug Pricing Program Database