Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330104 MONTEFIORE NYACK HOSPITAL

Covered Entity Details

Entity Name

MONTEFIORE NYACK HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330104

Entity Address

160 NORTH MIDLAND AVENUE
NYACK, NY 10960

Medicare Provider Number

330104

Participating Start Date

4/1/2006

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01030
280 SOUTH MAIN STREET
NEW CITY, NY 10956

Pharmacy Comments

Contract Details

Approval Date

10/21/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

John S. Burke, CFO
(845) 348-2107

Contract Pharmacy Representative

CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467

Signed By Date

10/21/2013

340B Drug Pricing Program Database