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CAREMARK TENNESSEE SPECIALTY PHARMACY, L
PED123300-00 KAPIOLANI MEDICAL CENTER FOR WOMEN & CHILDREN
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Covered Entity Details
Entity Name
KAPIOLANI MEDICAL CENTER FOR WOMEN & CHILDREN
Subdivision Name
Type
Children's Hospital
340B ID
PED123300-00
Entity Address
1319 PUNAHOU STREET
HONOLULU, HI 96826
Medicare Provider Number
123300
Participating Start Date
8/6/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
CAREMARK TENNESSEE SPECIALTY PHARMACY, L
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
8370 WOLF LAKE DR
STE 107
BARTLETT, TN 38133
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARTHA SMITH, Executive Vice President, Oahu Operations
(808) 522-2520
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/14/2019
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