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CAREMARK TENNESSEE SPECIALTY PHARMACY, L
DSH050441 STANFORD HEALTH CARE
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Covered Entity Details
Entity Name
STANFORD HEALTH CARE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050441
Entity Address
300 PASTEUR DRIVE
Stanford, CA 94305
Medicare Provider Number
050441
Participating Start Date
7/1/2015
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
CAREMARK TENNESSEE SPECIALTY PHARMACY, L
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
8370 WOLF LAKE DR
STE 107
BARTLETT, TN 38133
Pharmacy Comments
Contract Details
Approval Date
1/3/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Linda Hoff, CFO
(650) 497-0391
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/3/2022
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