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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390256 MILTON S. HERSHEY MEDICAL CENTER
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Covered Entity Details
Entity Name
MILTON S. HERSHEY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390256
Entity Address
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Medicare Provider Number
390256
Participating Start Date
4/1/2004
Last Recertification Date
9/24/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01653
635 CARLISLE ST.
HANOVER, PA 17331
Pharmacy Comments
Contract Details
Approval Date
4/8/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paula Marie Tinch, CFO & EVP Finance, PSH
(717) 531-1788
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/8/2021
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