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CVS ALBANY, L.L.C.
DSH330056 THE BROOKLYN HOSPITAL CENTER
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Covered Entity Details
Entity Name
THE BROOKLYN HOSPITAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330056
Entity Address
121 DEKALB AVE
BROOKLYN, NY 11201
Medicare Provider Number
330056
Participating Start Date
4/1/2005
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02769
4901 KINGS HIGHWAY
BROOKLYN, NY 11234
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
10/25/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/17/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Donald P. Minarcik, VP Revenue Enhancement
(718) 488-3775
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2021
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