Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330005 KALEIDA HEALTH

Covered Entity Details

Entity Name

KALEIDA HEALTH

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330005

Entity Address

100 High Street
BUFFALO, NY 14203

Medicare Provider Number

330005

Participating Start Date

4/1/2006

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

CVS PHARMACY # 16403
1750 WALDEN AVE
CHEEKTOWAGA, NY 14225

Pharmacy Comments

Contract Details

Approval Date

7/15/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Paul E Belter, EVP Chief Financial Officer
(716) 859-8836

Contract Pharmacy Representative

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

Signed By Date

7/15/2021

340B Drug Pricing Program Database