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CAREMARK ILLINOIS MAIL PHARMACY, LLC
STD33054 Community Life Support
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Covered Entity Details
Entity Name
Community Life Support
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33054
Entity Address
486-490 Fisherman Street,
Opalocka, FL 33054
Grant Number
NH25PS004342-04-01
Participating Start Date
1/1/2020
Last Recertification Date
5/9/2025
Pharmacy Details
Pharmacy Name
CAREMARK ILLINOIS MAIL PHARMACY, LLC
Pharmacy Address
DBA CVS/CAREMARK OR CARELONRX MAIL #8702
800 BIERMANN COURT
SUITE A
MOUNT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
7/10/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/14/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
PIERRE R. BLEMUR, M.D.
(305) 688-5456
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/10/2021
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