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CAREMARK TENNESSEE SPECIALTY PHARMACY, L
DSH370004 INTEGRIS MIAMI HOSPITAL
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Covered Entity Details
Entity Name
INTEGRIS MIAMI HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370004
Entity Address
200 2ND AVE. SW
MIAMI, OK 74354
Medicare Provider Number
370004
Participating Start Date
1/1/2023
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
CAREMARK TENNESSEE SPECIALTY PHARMACY, L
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
8370 WOLF LAKE DR
STE 107
BARTLETT, TN 38133
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/7/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Chris Hammes, Executive Vice President
(405) 949-3400
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2020
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