Contract Pharmacy Details

CAREMARK, L.L.C.
DSH110034 AU Medical Center, Inc.

Covered Entity Details

Entity Name

AU Medical Center, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH110034

Entity Address

1120 15TH ST.
AUGUSTA, GA 30912

Medicare Provider Number

110034

Participating Start Date

12/1/1992

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

CAREMARK, L.L.C.

Pharmacy Address

DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
7251 S. EASTERN AVE.
LAS VEGAS, NV 89119

Pharmacy Comments

Contract Details

Approval Date

7/6/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Timothy M. Gaillard, Chief Operating Officer
(706) 721-7228

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/6/2020

340B Drug Pricing Program Database