Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330163 EASTERN NIAGARA HOSPITAL

Covered Entity Details

Entity Name

EASTERN NIAGARA HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330163

Entity Address

521 EAST AVENUE
LOCKPORT, NY 14094

Medicare Provider Number

330163

Participating Start Date

4/16/2021

Last Recertification Date

8/16/2021

Entity Termination Date

1/1/2022

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00577
2972 SAUNDERS SETTLEMENT ROAD
SANBORN, NY 14132

Pharmacy Comments

Contract Details

Approval Date

4/16/2021

Contract Begin Date

6/3/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Michael Osborne, Vice President, Finance
(716) 828-2011

Contract Pharmacy Representative

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

Signed By Date

4/12/2021

340B Drug Pricing Program Database