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CAREMARK MASSACHUSETTS SPECIALTY PHARMAC
DSH060054 COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060054
Entity Address
2351 G ROAD
GRAND JUNCTION, CO 81505
Medicare Provider Number
060054
Participating Start Date
4/1/2021
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
CAREMARK MASSACHUSETTS SPECIALTY PHARMAC
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
25 BIRCH STREET, BLDG B, SUITE 100
MILFORD, MA 01757
Pharmacy Comments
Contract Details
Approval Date
10/13/2021
Contract Begin Date
10/13/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christian A. Thomas, CEO
(970) 644-3011
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/13/2021
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