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CAREMARK, L.L.C.
DSH330014A JAMAICA HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
JAMAICA HOSPITAL MEDICAL CENTER
Subdivision Name
THE JAMAICA HOSPITAL WOMEN'S HEALTH CENTER
Type
Disproportionate Share Hospital
340B ID
DSH330014A
Entity Address
133-03 JAMAICA AVENUE
RICHMOND HILLS, NY 11418
Medicare Provider Number
330014
Outpatient Facility Provider Number
Participating Start Date
1/1/2007
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
CAREMARK, L.L.C.
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
1127 BRYN MAWR AVE
SUITE A
REDLANDS, CA 92374
Pharmacy Comments
Contract Details
Approval Date
1/8/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/13/2020
Agreement registered in error
Contacts
Covered Entity Signing Official
MOUNIR F. DOSS, EXECUTIVE VP & CFO
(718) 206-6291
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/8/2020
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