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CAREMARK, L.L.C.
PED453304-00 Texas Children's Hospital
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Covered Entity Details
Entity Name
Texas Children's Hospital
Subdivision Name
Type
Children's Hospital
340B ID
PED453304-00
Entity Address
6621 Fannin Street
Houston, TX 77030-2303
Medicare Provider Number
453304
Participating Start Date
1/1/2012
Last Recertification Date
9/8/2024
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
1/10/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Weldon Gage, Executive Vice President/CFO
(832) 826-8084
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/10/2022
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