Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330169 MOUNT SINAI BETH ISRAEL

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 # 02557
253 FIRST AVENUE
NEW YORK, NY 10003

Pharmacy Comments

Contract Details

Approval Date

1/20/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Michael Bruno, Sr. Vice President
(212) 523-7140

Contract Pharmacy Representative

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

Signed By Date

1/20/2016

340B Drug Pricing Program Database