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CVS/SPECIALTY OR CARELONRX SPECIALTY PHA
DSH050360 MARIN GENERAL HOSPITAL
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Covered Entity Details
Entity Name
MARIN GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050360
Entity Address
250 BON AIR ROAD
GREENBRAE, CA 94904
Medicare Provider Number
050360
Participating Start Date
7/1/2016
Last Recertification Date
9/10/2024
Pharmacy Details
Pharmacy Name
CVS/SPECIALTY OR CARELONRX SPECIALTY PHA
Pharmacy Address
CAREMARK, LLC
1001 SPINKS ROAD, STE 280
FLOWER MOUND, TX 75028
Pharmacy Comments
Contract Details
Approval Date
10/7/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Elizabeth Lasnier, Controller
(415) 925-7449
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/7/2021
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