Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330065 NIAGARA FALLS MEMORIAL MEDICAL CENTER

Covered Entity Details

Entity Name

NIAGARA FALLS MEMORIAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330065

Entity Address

621-10TH STREET
NIAGARA FALLS, NY 14302

Medicare Provider Number

330065

Participating Start Date

10/1/2006

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00577
2972 SAUNDERS SETTLEMENT ROAD
SANBORN, NY 14132

Pharmacy Comments

Contract Details

Approval Date

4/9/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Raj Mehta, CFO/Vice President of Finance
(716) 278-4399

Contract Pharmacy Representative

CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467

Signed By Date

4/9/2015

340B Drug Pricing Program Database