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PROCARE PHARMACY, L.L.C.
DSH330013 ALBANY MEDICAL CENTER HOSPITAL
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Covered Entity Details
Entity Name
ALBANY MEDICAL CENTER HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330013
Entity Address
43 NEW SCOTLAND AVENUE
ALBANY, NY 12208
Medicare Provider Number
330013
Participating Start Date
4/1/2006
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #2923
3250 HARDEN ST. EXT. SUITE #300
COLUMBIA, SC 29203
Pharmacy Comments
Contract Details
Approval Date
7/16/2020
Contract Begin Date
9/2/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
FERDINAND J. VENDITTI, EXECUTIVE VP FOR SYSTEM CARE DELIVERY
(518) 262-5376
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/16/2020
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