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CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
DSH260061 NEVADA CITY HOSPITAL
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Covered Entity Details
Entity Name
NEVADA CITY HOSPITAL
Subdivision Name
DBA NEVADA REGIONAL MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH260061
Entity Address
800 SOUTH ASH STREET
NEVADA, MO 64772
Medicare Provider Number
260061
Participating Start Date
7/1/2009
Last Recertification Date
9/4/2024
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
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Lee Branstetter, CEO
(417) 448-3626
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2021
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