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CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
DSH330395 EPISCOPAL HEALTH SERVICES INC
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Covered Entity Details
Entity Name
EPISCOPAL HEALTH SERVICES INC
Subdivision Name
ST JOHN'S EPISCOPAL HOSPITAL - SOUTH SHORE
Type
Disproportionate Share Hospital
340B ID
DSH330395
Entity Address
327 BEACH 19TH STREET
FAR ROCKAWAY, NY 11691
Medicare Provider Number
330395
Participating Start Date
12/15/2005
Last Recertification Date
9/17/2024
Pharmacy Details
Pharmacy Name
CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
800 BIERMANN CT STE B
MOUNT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
4/26/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gerard M. Walsh, CEO
(718) 869-7320
Contract Pharmacy Representative
CVS HEALTH
Joan O'Rourke, VP Specialty Program Management
(847) 559-5282
Signed By Date
4/26/2017
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