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PHARMACY ASSOC OF GLENS FALLS
RRC330094-00 Columbia Memorial Hospital
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Covered Entity Details
Entity Name
Columbia Memorial Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC330094-00
Entity Address
71 Prospect Aveune
Hudson, NY 12534
Medicare Provider Number
330094
Participating Start Date
10/1/2013
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
PHARMACY ASSOC OF GLENS FALLS
Pharmacy Address
OMNICARE OF BALLSTON SPA
14 COMMERCE DR
BALLSTON SPA, NY 12020-3631
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
2/15/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bryan T. Mahoney, Chief Financial Officer
(518) 697-3230
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/17/2023
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