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CAREMARK, L.L.C.
CH052760 CRUSADERS CENTRAL CLINIC ASSOCIATION
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Covered Entity Details
Entity Name
CRUSADERS CENTRAL CLINIC ASSOCIATION
Subdivision Name
Crusader Clinic on West State Street
Type
HRSA-Funded Health Center
340B ID
CH052760
Entity Address
1200 W State St
Rockford, IL 61102-2112
Grant Number
H80CS00113
Participating Start Date
12/1/1992
Last Recertification Date
2/18/2025
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
4/14/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Samuel Miller, President/CEO
(815) 490-1600
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/14/2022
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