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CVS CAREMARK
CAH521317-00 Ascension Calumet Hospital, Inc.
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Covered Entity Details
Entity Name
Ascension Calumet Hospital, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521317-00
Entity Address
614 MEMORIAL DRIVE
CHILTON, WI 53014
Medicare Provider Number
521317
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
CVS CAREMARK
Pharmacy Address
DBA CVS/CAREMARK OR CF# 11506
1 GREAT VALLEY BOULEVARD
WILKES BARRE, PA 18706
Pharmacy Comments
Contract Details
Approval Date
1/11/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Vanessa Freitag, Vice President, Pharmacy
(715) 897-1183
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/11/2022
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