Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330157 SAMARITAN MEDICAL CENTER

Covered Entity Details

Entity Name

SAMARITAN MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330157

Entity Address

830 WASHINGTON STREET
WATERTOWN, NY 13601

Medicare Provider Number

330157

Participating Start Date

10/1/2020

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

CVS/PHARMACY # 17328
21800 TOWNE CENTER DR
WATERTOWN, NY 13601

Pharmacy Comments

Contract Details

Approval Date

1/12/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Maxine A Briggs, VP Of Fiscal Services/Chief Financial Officer
(315) 755-3605

Contract Pharmacy Representative

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

Signed By Date

1/12/2023

340B Drug Pricing Program Database