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EXPRESS SCRIPTS PHARMACY, INC.
CAH051324-00 NORTHERN INYO HOSPITAL
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Covered Entity Details
Entity Name
NORTHERN INYO HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051324-00
Entity Address
150 PIONEER LANE
BISHOP, CA 93514
Medicare Provider Number
051324
Participating Start Date
8/17/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
EXPRESS SCRIPTS PHARMACY, INC.
Pharmacy Address
DBA EXPRESS SCRIPTS
2040 ROUTE 130 NORTH
BURLINGTON, NJ 08016
Pharmacy Comments
Contract Details
Approval Date
1/15/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/22/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kelli Rae Davis, Interim CEO
(760) 873-5811 Ext: 2109
Contract Pharmacy Representative
Acreedo Specialty
Gene McCabe, Senior Director
(615) 943-7500
Signed By Date
1/15/2022
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