Contract Pharmacy Details

CAREMARK ILLINOIS MAIL PHARMACY, LLC
CH034100 PORTSMOUTH COMMUNITY HEALTH CENTER, INC.,d/b/a Hampton Roads Community Health Center

Covered Entity Details

Entity Name

PORTSMOUTH COMMUNITY HEALTH CENTER, INC.,d/b/a Hampton Roads Community Health Center

Subdivision Name

PORTSMOUTH COMMUNITY HEALTH CENTER, INC.

Type

HRSA-Funded Health Center

340B ID

CH034100

Entity Address

664 Lincoln St
Portsmouth, VA 23704-4818

Grant Number

H80CS00729

Participating Start Date

1/1/1994

Last Recertification Date

1/31/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

CAREMARK ILLINOIS MAIL PHARMACY, LLC

Pharmacy Address

DBA CVS/CAREMARK OR CARELONRX MAIL #8702
800 BIERMANN COURT
SUITE A
MOUNT PROSPECT, IL 60056

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

10/1/2020
Agreement registered in error

Contacts

Covered Entity Signing Official

Barbara Willis, CEO
(757) 393-6363

Contract Pharmacy Representative

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

Signed By Date

7/16/2020

340B Drug Pricing Program Database