Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330014 JAMAICA HOSPITAL MEDICAL CENTER

Covered Entity Details

Entity Name

JAMAICA HOSPITAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330014

Entity Address

8900 VAN WYCK EXPRESSWAY
JAMAICA, NY 11418

Medicare Provider Number

330014

Participating Start Date

10/1/2004

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02400
1223 2ND AVENUE
NEW YORK, NY 10065

Pharmacy Comments

Contract Details

Approval Date

7/12/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/10/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

MOUNIR F. DOSS, EXECUTIVE VP & CFO
(718) 206-6291

Contract Pharmacy Representative

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

Signed By Date

7/12/2021

340B Drug Pricing Program Database