Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330024 THE MOUNT SINAI HOSPITAL

Covered Entity Details

Entity Name

THE MOUNT SINAI HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330024

Entity Address

ONE GUSTAVE L. LEVY PLACE
NEW YORK, NY 10029

Medicare Provider Number

330024

Participating Start Date

7/1/2004

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05772
1500 LEXINGTON AVE.
NEW YORK, NY 10029

Pharmacy Comments

Contract Details

Approval Date

10/27/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

KENNETH DAVIS, CEO
(212) 659-8888

Contract Pharmacy Representative

CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241

Signed By Date

10/27/2014

340B Drug Pricing Program Database