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CVS ALBANY, L.L.C.
DSH330169 MOUNT SINAI BETH ISRAEL
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Covered Entity Details
Entity Name
MOUNT SINAI BETH ISRAEL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330169
Entity Address
FIRST AVENUE AT 16TH STREET
NEW YORK, NY 10003
Medicare Provider Number
330169
Participating Start Date
7/1/2005
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 10612
65 FIFTH AVENUE
NEW YORK, NY 10003
Pharmacy Comments
Contract Details
Approval Date
1/19/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/23/2019
Contacts
Covered Entity Signing Official
Michael Bruno, Sr. Vice President
(212) 523-7140
Contract Pharmacy Representative
CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467
Signed By Date
1/19/2015
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