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CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
CAH131312-00 ST. LUKE'S MCCALL, LTD
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Covered Entity Details
Entity Name
ST. LUKE'S MCCALL, LTD
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131312-00
Entity Address
1000 State Street
MCCALL, ID 83638
Medicare Provider Number
131312
Participating Start Date
1/1/2013
Last Recertification Date
8/28/2024
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
7/30/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peter DiDio, Vice President, Controller
(208) 381-1251
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/30/2021
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