Contract Pharmacy Details

CVS ALBANY, L.L.C.
CAH331312-00 DELAWARE VALLEY HOSPITAL INC.

Covered Entity Details

Entity Name

DELAWARE VALLEY HOSPITAL INC.

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH331312-00

Entity Address

1 TITUS PLACE
WALTON, NY 13856

Medicare Provider Number

331312

Participating Start Date

1/1/2011

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05019
215 DELAWARE STREET
WALTON, NY 13856

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

LuCinda M Rider, Chief Financial Officer
(607) 865-2190

Contract Pharmacy Representative

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

Signed By Date

10/15/2021

340B Drug Pricing Program Database