Contract Pharmacy Details

CAREMARK, L.L.C.
HV16214 Pennsylvania Western University

Covered Entity Details

Entity Name

Pennsylvania Western University

Subdivision Name

PA Thrive Partnership - Clarion

Type

Ryan White Part C

340B ID

HV16214

Entity Address

1008 S. 5th Ave.
Suite 201
Clarion, PA 16214

Grant Number

H76HA48995

Participating Start Date

10/1/2003

Last Recertification Date

2/10/2025

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

1/15/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/29/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Amy Heather Esterhuizen, GRANTS OFFICER
(814) 393-2162

Contract Pharmacy Representative

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

Signed By Date

1/15/2021

340B Drug Pricing Program Database