Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330065 NIAGARA FALLS MEMORIAL MEDICAL CENTER

Covered Entity Details

Entity Name

NIAGARA FALLS MEMORIAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330065

Entity Address

621-10TH STREET
NIAGARA FALLS, NY 14302

Medicare Provider Number

330065

Participating Start Date

10/1/2006

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05496
9300 TRANSIT RD
EAST AMHERST, NY 14051

Pharmacy Comments

Contract Details

Approval Date

7/14/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/26/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Mark Wright, Senior Vice President/Finance
(716) 278-4399

Contract Pharmacy Representative

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

Signed By Date

7/14/2020

340B Drug Pricing Program Database