340B Drug Pricing Program Database
CAREMARK NORTH CAROLINA SPECIALTY PHARMA
DSH520177 FROEDTERT MEMORIAL LUTHERAN HOSPITAL - information as of 5/16/2025 11:35:16 AM
Covered Entity Details
Entity Name
FROEDTERT MEMORIAL LUTHERAN HOSPITAL
Subdivision Name
FORMERLY JOHN L. DOYNE HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH520177
Entity Address
9200 WEST WISCONSIN AVENUE
MILWAUKEE, WI 53226
Medicare Provider Number
520177
Participating Start Date
7/1/1996
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
CAREMARK NORTH CAROLINA SPECIALTY PHARMA
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
10700 WORLD TRADE BLVD STE 110
RALEIGH, NC 27617
Pharmacy Comments
Contract Details
Approval Date
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Klauck, Senior Vice President, Ancillary Services
(414) 777-1925
Contract Pharmacy Representative
Bill Lindsey, Manager
(919) 833-3993
Signed By Date
4/15/2016
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