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CVS ALBANY, L.L.C.
DSH330232 SETON HEALTH SYSTEM
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Covered Entity Details
Entity Name
SETON HEALTH SYSTEM
Subdivision Name
St. Mary's Hospital
Type
Disproportionate Share Hospital
340B ID
DSH330232
Entity Address
1300 MASSACHUSETTS AVE
TROY, NY 12180
Medicare Provider Number
330232
Participating Start Date
10/1/2009
Last Recertification Date
8/28/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00375
260 DELAWARE AVENUE
DELMAR, NY 12054
Pharmacy Comments
Contract Details
Approval Date
4/24/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Daniel Kochie, CFO
(518) 268-5335
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
4/24/2014
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