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CAREMARK, L.L.C.
RRC500072-00 OLYMPIC MEDICAL CENTER
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Covered Entity Details
Entity Name
OLYMPIC MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC500072-00
Entity Address
939 CAROLINE STREET
PORT ANGELES, WA 98362
Medicare Provider Number
500072
Participating Start Date
10/1/2015
Last Recertification Date
9/3/2024
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
1/18/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/9/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Darryl Wolfe, Chief Executive Officer
(360) 417-7705
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/18/2021
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