Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330073 UNITED MEMORIAL MEDICAL CENTER

Covered Entity Details

Entity Name

UNITED MEMORIAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330073

Entity Address

127 NORTH STREET
BATAVIA, NY 14020

Medicare Provider Number

330073

Participating Start Date

1/1/2010

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02218
3750 MOUNT READ BLVD.
ROCHESTER, NY 14616

Pharmacy Comments

Contract Details

Approval Date

4/15/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/5/2022
Pharmacy closed

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

340B Drug Pricing Program Database