Contract Pharmacy Details

CAREMARK TENNESSEE SPECIALTY PHARMACY, L
DSH100034 MOUNT SINAI MEDICAL CENTER

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 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

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

340B Drug Pricing Program Database