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CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
DSH140054 MACNEAL HOSPITAL
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Covered Entity Details
Entity Name
MACNEAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140054
Entity Address
3249 SOUTH OAK PARK AVENUE
BERWYN, IL 60402
Medicare Provider Number
140054
Participating Start Date
1/1/2019
Last Recertification Date
9/10/2024
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
4/12/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Paul Isacksen, EVP and Regional CFO
(708) 216-4252
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/12/2021
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