Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330128 ELMHURST HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

ELMHURST HOSPITAL CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330128

Entity Address

79-01 BROADWAY
ELMHURST, NY 11373

Medicare Provider Number

330128

Participating Start Date

12/1/1992

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01113
89-11 NORTHERN BLVD.
JACKSON HEIGHTS, NY 11372

Pharmacy Comments

Contract Details

Approval Date

7/23/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

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