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CVS ALBANY, L.L.C.
DSH330238 NICHOLAS H. NOYES MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
NICHOLAS H. NOYES MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330238
Entity Address
111 CLARA BARTON STREET
DANSVILLE, NY 14437
Medicare Provider Number
330238
Participating Start Date
10/1/2017
Last Recertification Date
8/15/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05073
15 HONEOYE COMMONS
HONEOYE, NY 14471
Pharmacy Comments
Contract Details
Approval Date
10/12/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mark F Prunoske, SVP/CFO
(585) 335-4306
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/12/2020
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