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CVS ALBANY, L.L.C.
DSH330046 MOUNT SINAI WEST
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Covered Entity Details
Entity Name
MOUNT SINAI WEST
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330046
Entity Address
1000 TENTH AVENUE
NEW YORK, NY 10019
Medicare Provider Number
330046
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 # 02168
1 COLUMBUS PLACE
NEW YORK, NY 10019
Pharmacy Comments
Contract Details
Approval Date
10/16/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/9/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Bruno, Sr. Vice President
(212) 523-7140
Contract Pharmacy Representative
CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
10/16/2014
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