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CVS ALBANY, L.L.C.
DSH330265 Clifton Springs Hospital
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Covered Entity Details
Entity Name
Clifton Springs Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330265
Entity Address
2 Coulter Road
Clifton Springs, NY 14432
Medicare Provider Number
330265
Participating Start Date
7/1/2012
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01286
1215 ROUTE 31
MACEDON, NY 14502
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hugh Thomas, Executive Vice President, Chief Administrative Officer
(585) 922-4941
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2021
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