Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330204 BELLEVUE HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

BELLEVUE HOSPITAL CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330204

Entity Address

462 FIRST AVENUE @ 27TH STREET
D/B/A NYC HEALTH & HOSPITAL CORP
NEW YORK, NY 10016

Medicare Provider Number

330204

Participating Start Date

8/1/1993

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

CVS/PHARMACY # 17728
400 GRAND STREET
NEW YORK, NY 10002

Pharmacy Comments

Contract Details

Approval Date

10/17/2022

Contract Begin Date

1/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Deborah Alyse Brown, Senior Vice President, Chief External Affairs Officer
(347) 947-0446

Contract Pharmacy Representative

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

Signed By Date

10/17/2022

340B Drug Pricing Program Database