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CAREMARK ILLINOIS MAIL PHARMACY, LLC
PED393302-00 UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
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Covered Entity Details
Entity Name
UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
Subdivision Name
Type
Children's Hospital
340B ID
PED393302-00
Entity Address
4401 PENN AVENUE
PITTSBURGH, PA 15224
Medicare Provider Number
393302
Participating Start Date
1/1/2010
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
CAREMARK ILLINOIS MAIL PHARMACY, LLC
Pharmacy Address
DBA CVS/CAREMARK OR CARELONRX MAIL #8702
800 BIERMANN COURT
SUITE A
MOUNT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
4/8/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/8/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mario Edward Wilfong, CFO
(412) 692-8201
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/8/2021
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