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RITE AID OF NEW YORK, INC.
DSH330013 ALBANY MEDICAL CENTER HOSPITAL
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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 #537
17-21 NORTH PEARL STREET
ALBANY, NY 12207
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
3/15/2018
Ownership change
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
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