Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330046 MOUNT SINAI WEST

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

CVS/PHARMACY # 10235
800 10TH AVE.
NEW YORK, NY 10019

Pharmacy Comments

Contract Details

Approval Date

7/17/2017

Contract Begin Date

10/1/2017

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

Signed By Date

7/17/2017

340B Drug Pricing Program Database