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CAREMARK PUERTO RICO SPECIALTY PHARMACY,
DSH030064 Banner - University Medical Center Tucson
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Covered Entity Details
Entity Name
Banner - University Medical Center Tucson
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030064
Entity Address
1625 North Campbell Avenue
TUCSON, AZ 85719
Medicare Provider Number
030064
Participating Start Date
1/1/1997
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
CAREMARK PUERTO RICO SPECIALTY PHARMACY,
Pharmacy Address
CAREMARK PUERTO RICO SPECIALTY PHARMACY
6020 AVE ROBERTO SANCHEZ VILELLA
CAROLINA, PR 00982
Pharmacy Comments
Contract Details
Approval Date
7/16/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brad Hipp, Chief Financial Officer
(520) 694-3446
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/16/2020
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