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CAREMARK NEW JERSEY SPECIALTY PHCY, LLC
DSH500088 PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER
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Covered Entity Details
Entity Name
PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500088
Entity Address
400 S 43RD STREET
RENTON, WA 98055-5010
Medicare Provider Number
500088
Participating Start Date
10/4/2005
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
CAREMARK NEW JERSEY SPECIALTY PHCY, LLC
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
180 PASSAIC AVE UNIT B-5
FAIRFIELD, NJ 07004
Pharmacy Comments
Contract Details
Approval Date
4/9/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jeannine Grinnell, Vice President of Finance
(425) 228-3440 Ext: 4268
Contract Pharmacy Representative
CVS
Tony Russo, Senior Director, Specialty Product Development
(973) 461-1550
Signed By Date
4/9/2017
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