Contract Pharmacy Details

CVS ALBANY, L.L.C.
RRC330191-00 GLENS FALLS HOSPITAL

Covered Entity Details

Entity Name

GLENS FALLS HOSPITAL

Subdivision Name

Type

Rural Referral Center

340B ID

RRC330191-00

Entity Address

100 PARK ST
GLENS FALLS, NY 12801

Medicare Provider Number

330191

Participating Start Date

8/18/2020

Last Recertification Date

9/15/2021

Entity Termination Date

10/1/2022

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05348
1169 ROUTE 29
GREENWICH, NY 12834

Pharmacy Comments

Contract Details

Approval Date

7/21/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Paul J Scimeca, Senior Vice President/Chief Operating Officer
(518) 926-5902

Contract Pharmacy Representative

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

Signed By Date

7/15/2020

340B Drug Pricing Program Database