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CRESTWOOD HEALTH INC.
RW4248550 The Albany Damien Center Inc.
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Covered Entity Details
Entity Name
The Albany Damien Center Inc.
Subdivision Name
Type
Ryan White Part D
340B ID
RW4248550
Entity Address
728 Madison Ave
Suite 100
Albany, NY 12208-3302
Grant Number
H12HA24855
Participating Start Date
1/1/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
CRESTWOOD HEALTH INC.
Pharmacy Address
CRESTWOOD PHARMACY
26-A PICOTTE DR.
ATTN: SUPERVISING PHARMACIST
ALBANY, NY 12208
Pharmacy Comments
Contract Details
Approval Date
7/10/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Perry Junjulas, Executive Director
(518) 449-7119 Ext: 102
Contract Pharmacy Representative
Crestwood Health, Inc.
Jagat Patel, Pharmacist-CEO
(518) 435-2315
Signed By Date
7/10/2024
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