Contract Pharmacy Details

RITE AID OF NEW YORK, INC.
DSH330013 ALBANY MEDICAL CENTER HOSPITAL

Covered Entity Details

Entity Name

ALBANY MEDICAL CENTER HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330013

Entity Address

43 NEW SCOTLAND AVENUE
ALBANY, NY 12208

Medicare Provider Number

330013

Participating Start Date

4/1/2006

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #4928
1863 CENTRAL AVENUE
COLONIE, NY 12205

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

6/16/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

FERDINAND J. VENDITTI, EXECUTIVE VP FOR SYSTEM CARE DELIVERY
(518) 262-5376

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

7/17/2017

340B Drug Pricing Program Database