Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH100093 BAPTIST HOSPITAL

Covered Entity Details

Entity Name

BAPTIST HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH100093

Entity Address

123 Baptist Way
PENSACOLA, FL 32503

Medicare Provider Number

100093

Participating Start Date

4/1/2009

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

CVS/PHARMACY #11186
1806 PINE AVE.
NIAGARA FALLS, NY 14301

Pharmacy Comments

Contract Details

Approval Date

4/27/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/29/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Andrew L. Terry, Vice President Revenue Management
(850) 469-7643

Contract Pharmacy Representative

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

Signed By Date

4/27/2021

340B Drug Pricing Program Database