Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330047 ST. MARYS HEALTHCARE

Covered Entity Details

Entity Name

ST. MARYS HEALTHCARE

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330047

Entity Address

427 GUY PARK AVENUE
AMSTERDAM, NY 12010

Medicare Provider Number

330047

Participating Start Date

10/1/2009

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05027
625 E. MAIN ST.
LITTLE FALLS, NY 13365

Pharmacy Comments

Contract Details

Approval Date

10/13/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Rick Henze, Vice President of Finance/CFO
(518) 841-7435

Contract Pharmacy Representative

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

Signed By Date

10/13/2020

340B Drug Pricing Program Database