Contract Pharmacy Details

CAREMARK, L.L.C.
SCH450571-00 SHANNON MEDICAL CENTER

Covered Entity Details

Entity Name

SHANNON MEDICAL CENTER

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH450571-00

Entity Address

120 EAST HARRIS AVENUE
SAN ANGELO, TX 76903

Medicare Provider Number

450571

Participating Start Date

7/1/2021

Last Recertification Date

8/19/2021

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

5/10/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Joseph Wooldridge, Chief Financial Officer
(325) 657-5303

Contract Pharmacy Representative

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

Signed By Date

5/7/2021

340B Drug Pricing Program Database