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CVS ALBANY, L.L.C.
DSH330194 MAIMONIDES MEDICAL CENTER
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Covered Entity Details
Entity Name
MAIMONIDES MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330194
Entity Address
4802 TENTH AVE.
BROOKLYN, NY 11219
Medicare Provider Number
330194
Participating Start Date
10/1/2004
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02700
1402 SHEEPSHEAD BAY ROAD
BROOKLYN, NY 11235
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KENNETH D. GIBBS, CEO
(718) 283-6575
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2021
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