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CMV PHARMACY INC.
DSH330241 UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330241
Entity Address
750 East Adams Street
Syracuse, NY 13210
Medicare Provider Number
330241
Participating Start Date
7/1/2005
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
CMV PHARMACY INC.
Pharmacy Address
DBA DOUGHERTY PHARMACY
14 E MAIN ST.
PO BOX 237
MORRISVILLE, NY 13408
Pharmacy Comments
Contract Details
Approval Date
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stuart M. Wright, Chief Financial Officer
(315) 464-5179
Contract Pharmacy Representative
Browns Prescription Pharmacy, Inc
Colin Valenta, President
(607) 467-2298
Signed By Date
10/9/2023
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