Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330385 NORTH CENTRAL BRONX HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

NORTH CENTRAL BRONX HOSPITAL CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330385

Entity Address

3424 KOSSUTH AVE.
BRONX, NY 10467

Medicare Provider Number

330385

Participating Start Date

12/1/1992

Last Recertification Date

8/16/2021

Entity Termination Date

10/1/2021

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02433
2112 WHITE PLAINS ROAD
BRONX, NY 10462

Pharmacy Comments

Contract Details

Approval Date

7/23/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/12/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479

Contract Pharmacy Representative

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

Signed By Date

7/23/2014

340B Drug Pricing Program Database