Contract Pharmacy Details

CAREMARK, L.L.C.
RRC250100-00 BAPTIST MEM HOSPITAL GOLDEN TRIANGLE

Covered Entity Details

Entity Name

BAPTIST MEM HOSPITAL GOLDEN TRIANGLE

Subdivision Name

Type

Rural Referral Center

340B ID

RRC250100-00

Entity Address

2520 FIFTH STREET NORTH
COLUMBUS, MS 39701

Medicare Provider Number

250100

Participating Start Date

4/1/2022

Last Recertification Date

Entity Termination Date

4/1/2022

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

2/1/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kimberly Young, Vice President-Finance Operations
(901) 227-4080

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/13/2022

340B Drug Pricing Program Database