Contract Pharmacy Details

CAREMARK, L.L.C.
STD02910 CODAC Behavioral Healthcare, Inc

Covered Entity Details

Entity Name

CODAC Behavioral Healthcare, Inc

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD02910

Entity Address

1052 Park Ave
Cranston, RI 02910

Grant Number

6 NH25PS005160-02-02

Participating Start Date

10/1/2020

Last Recertification Date

5/5/2021

Entity Termination Date

7/1/2022

Pharmacy Details

Pharmacy Name

CAREMARK, L.L.C.

Pharmacy Address

DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
7251 S. EASTERN AVE.
LAS VEGAS, NV 89119

Pharmacy Comments

Contract Details

Approval Date

4/15/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Linda Hurley, CEO
(401) 275-5037

Contract Pharmacy Representative

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

Signed By Date

4/15/2021

340B Drug Pricing Program Database