Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330204 BELLEVUE HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

BELLEVUE HOSPITAL CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330204

Entity Address

462 FIRST AVENUE @ 27TH STREET
D/B/A NYC HEALTH & HOSPITAL CORP
NEW YORK, NY 10016

Medicare Provider Number

330204

Participating Start Date

8/1/1993

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY # 4958
27 N. 6TH ST.
BROOKLYN, NY 11249

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

Paul Albertson, Vice President
(212) 748-2256

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