Contract Pharmacy Details

CORAM HEALTHCARE CORPORATION OF GREATER
DSH330013 ALBANY MEDICAL CENTER HOSPITAL

Covered Entity Details

Entity Name

ALBANY MEDICAL CENTER HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330013

Entity Address

43 NEW SCOTLAND AVENUE
ALBANY, NY 12208

Medicare Provider Number

330013

Participating Start Date

4/1/2006

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

CORAM HEALTHCARE CORPORATION OF GREATER

Pharmacy Address

DBA CORAM CVS/SPECIALTY INFUSION SERVICE
12 JUPITER LANE
ALBANY, NY 12205-6918

Pharmacy Comments

Contract Details

Approval Date

7/12/2021

Contract Begin Date

7/28/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/2/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

FERDINAND J. VENDITTI, EXECUTIVE VP FOR SYSTEM CARE DELIVERY
(518) 262-5376

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