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CVS ALBANY, L.L.C.
DSH330055 NEWYORK-PRESBYTERIAN / QUEENS
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Covered Entity Details
Entity Name
NEWYORK-PRESBYTERIAN / QUEENS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330055
Entity Address
56-45 MAIN STREET
FLUSHING, NY 11355
Medicare Provider Number
330055
Participating Start Date
4/1/2005
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02436
1346 PENNSYLVANIA AVENUE
BROOKLYN, NY 11239
Pharmacy Comments
Contract Details
Approval Date
4/5/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kevin Ward, Senior VP FOR FINANCE
(718) 670-1476
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/5/2021
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