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CAREMARK, L.L.C.
DSH050471 PIH HEALTH GOOD SAMARITAN HOSPITAL
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Covered Entity Details
Entity Name
PIH HEALTH GOOD SAMARITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050471
Entity Address
1225 Wilshire Blvd
LOS ANGELES, CA 90017-2395
Medicare Provider Number
050471
Participating Start Date
7/1/2008
Last Recertification Date
8/27/2024
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
10/26/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/15/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JAMES R. WEST, PRESIDENT and CEO
(562) 698-0811 Ext: 12413
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/26/2021
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