Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330231 QUEENS HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

QUEENS HOSPITAL CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330231

Entity Address

82-68 164TH ST.
JAMAICA, NY 11432

Medicare Provider Number

330231

Participating Start Date

12/1/1992

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY #17806
160-08 JAMAICA AVENUE
JAMAICA, NY 11432

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