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CAREMARK KANSAS SPECIALTY PHARMACY
DSH100034 MOUNT SINAI MEDICAL CENTER
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Covered Entity Details
Entity Name
MOUNT SINAI MEDICAL CENTER
Subdivision Name
MOUNT SINAI MEDICAL CENTER OF FLORIDA INC.
Type
Disproportionate Share Hospital
340B ID
DSH100034
Entity Address
4300 Alton Road
MIAMI BEACH, FL 33140
Medicare Provider Number
100034
Participating Start Date
4/1/2007
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
CAREMARK KANSAS SPECIALTY PHARMACY
Pharmacy Address
CVS/SPECIALTY OR CARELONRX SPECIALTY PHA
11162 RENNER BLVD
LENEXA, KS 66219
Pharmacy Comments
Contract Details
Approval Date
6/10/2019
Contract Begin Date
6/10/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/6/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ANGEL PALLIN, SVP OF OPERATIONS
(305) 674-2520
Contract Pharmacy Representative
CVS
Kimberly Pirtle, Senior Professional Pharmacist Program Manager
(423) 680-1936
Signed By Date
6/10/2019
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