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CVS ALBANY, L.L.C.
CH02179Z HUDSON HEADWATERS HEALTH NETWORK
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Covered Entity Details
Entity Name
HUDSON HEADWATERS HEALTH NETWORK
Subdivision Name
Elderwood at Ticonderoga
Type
HRSA-Funded Health Center
340B ID
CH02179Z
Entity Address
1019 Wicker St
Ticonderoga, NY 12883-1039
Grant Number
H80CS00159
Participating Start Date
7/1/2021
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02685
1253 DIX AVE.
HUDSON FALLS, NY 12839
Pharmacy Comments
Contract Details
Approval Date
4/13/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laura Pasco, EVP, Chief Financial Officer
(518) 761-0300 Ext: 31553
Contract Pharmacy Representative
CVS
Walter Jury, Account Manager
(315) 271-5312
Signed By Date
4/13/2025
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