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CAREMARK, L.L.C.
DSH130071 St. Luke's Nampa Medical Center
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Covered Entity Details
Entity Name
St. Luke's Nampa Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH130071
Entity Address
9850 W ST LUKES DRIVE
Nampa, ID 83687
Medicare Provider Number
130071
Participating Start Date
7/1/2019
Last Recertification Date
8/27/2024
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
10/9/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peter DiDio, Vice President, Controller
(208) 381-1251
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/9/2020
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