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CAREMARK, L.L.C.
DSH210034 HARBOR HOSPITAL INC.
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Covered Entity Details
Entity Name
HARBOR HOSPITAL INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210034
Entity Address
3001 SOUTH HANOVER STREET
BALTIMORE, MD 21225
Medicare Provider Number
210034
Participating Start Date
10/1/2003
Last Recertification Date
8/16/2024
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
Contacts
Covered Entity Signing Official
Robert P. Lally Jr., CFO
(443) 777-7257
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2021
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