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CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
HV01713 MetroHealth
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Covered Entity Details
Entity Name
MetroHealth
Subdivision Name
Type
Ryan White Part C
340B ID
HV01713
Entity Address
1012 14TH STREET, NW
SUITE 700
WASHINGTON, DC 20005
Grant Number
H89HA00012
Participating Start Date
7/1/2009
Last Recertification Date
1/29/2019
Entity Termination Date
1/1/2020
Pharmacy Details
Pharmacy Name
CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
800 BIERMANN CT STE B
MOUNT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
7/13/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
LLOYD H. BUCKNER, EXECUTIVE DIRECTOR
(202) 638-0750
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/13/2018
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