Contract Pharmacy Details

CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
DSH500088 PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER

Covered Entity Details

Entity Name

PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH500088

Entity Address

400 S 43RD STREET
RENTON, WA 98055-5010

Medicare Provider Number

500088

Participating Start Date

10/4/2005

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC

Pharmacy Address

DBA CVS/CAREMARK 48067
1780 WALL ST
MT PROSPECT, IL 60056

Pharmacy Comments

Contract Details

Approval Date

2/17/2021

Contract Begin Date

2/17/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jeannine Grinnell, Chief Executive and Financial Officer
(425) 690-3310

Contract Pharmacy Representative

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

Signed By Date

2/17/2021

340B Drug Pricing Program Database