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CVS ALBANY, L.L.C.
DSH330065 NIAGARA FALLS MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
NIAGARA FALLS MEMORIAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330065
Entity Address
621-10TH STREET
NIAGARA FALLS, NY 14302
Medicare Provider Number
330065
Participating Start Date
10/1/2006
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
CVS/PHARMACY #11186
1806 PINE AVE.
NIAGARA FALLS, NY 14301
Pharmacy Comments
Contract Details
Approval Date
1/8/2018
Contract Begin Date
1/9/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/26/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Raj Mehta, CFO/Vice President of Finance
(716) 278-4399
Contract Pharmacy Representative
CVS Health
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
1/8/2018
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