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CAREMARK PUERTO RICO SPECIALTY PHARMACY,
CAH261306-00 SULLIVAN COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SULLIVAN COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261306-00
Entity Address
630 WEST THIRD STREET
MILAN, MO 63556
Medicare Provider Number
261306
Participating Start Date
10/1/2015
Last Recertification Date
8/27/2024
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
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tony Keene, CEO
(660) 265-4212 Ext: 610
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2020
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