Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330024 THE MOUNT SINAI HOSPITAL

Covered Entity Details

Entity Name

THE MOUNT SINAI HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330024

Entity Address

ONE GUSTAVE L. LEVY PLACE
NEW YORK, NY 10029

Medicare Provider Number

330024

Participating Start Date

7/1/2004

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01113
89-11 NORTHERN BLVD.
JACKSON HEIGHTS, NY 11372

Pharmacy Comments

Contract Details

Approval Date

7/14/2021

Contract Begin Date

7/21/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Michael Pastier, Senior VP/CFO - The Mount Sinai Hospital
(212) 731-3149

Contract Pharmacy Representative

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

Signed By Date

7/14/2021

340B Drug Pricing Program Database