Contract Pharmacy Details

CVS ALBANY, L.L.C.
DSH330240 HARLEM HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

HARLEM HOSPITAL CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330240

Entity Address

506 LENOX AVENUE
NEW YORK, NY 10037

Medicare Provider Number

330240

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 # 00144
219-39 89TH AVENUE
QUEENS VILLAGE, NY 11427

Pharmacy Comments

Contract Details

Approval Date

7/6/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/2/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Paul Albertson, Vice President
(212) 748-2256

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/6/2017

340B Drug Pricing Program Database