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CVS ALBANY, L.L.C.
DSH330286 GOOD SAMARITAN HOSPITAL
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Covered Entity Details
Entity Name
GOOD SAMARITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330286
Entity Address
1000 MONTAUK HIGHWAY
WEST ISLIP, NY 11795
Medicare Provider Number
330286
Participating Start Date
11/7/2022
Last Recertification Date
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00922
499 MONTAUK HIGHWAY
WEST ISLIP, NY 11795
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
1/19/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/4/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Stephen Trapani, SVP Finance
(631) 376-3583
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/17/2023
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