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CAREMARK, L.L.C.
RRC270014-00 ST PATRICK HOSPITAL
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Covered Entity Details
Entity Name
ST PATRICK HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC270014-00
Entity Address
500 W. BROADWAY ST
MISSOULA, MT 59802
Medicare Provider Number
270014
Participating Start Date
7/1/2021
Last Recertification Date
8/25/2021
Entity Termination Date
10/1/2022
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
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kirk Bodlovic, Chief Operating Officer
(406) 327-1740
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2022
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