Contract Pharmacy Details

CVS CAREMARK
CAH011305-00 St. Vincent's Blount

Covered Entity Details

Entity Name

St. Vincent's Blount

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH011305-00

Entity Address

150 Gilbreath Drive
Oneonta, AL 35121

Medicare Provider Number

011305

Participating Start Date

1/1/2014

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

CVS CAREMARK

Pharmacy Address

DBA CVS/CAREMARK OR CF# 11506
1 GREAT VALLEY BOULEVARD
WILKES BARRE, PA 18706

Pharmacy Comments

Contract Details

Approval Date

1/14/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Gregory Dale Brown, Administrator
(205) 274-3010

Contract Pharmacy Representative

St. Vincents Blount
Gavin Keith Gilliland, Director of Pharmacy
(205) 274-3337

Signed By Date

1/14/2021

340B Drug Pricing Program Database