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CAREMARK KANSAS SPECIALTY PHARMACY
CAH051333-00 Ridgecrest Regional Hospital
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Covered Entity Details
Entity Name
Ridgecrest Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051333-00
Entity Address
1081 N. China Lake Blvd.
Ridgecrest, CA 93555
Medicare Provider Number
051333
Participating Start Date
10/1/2013
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CAREMARK KANSAS SPECIALTY PHARMACY
Pharmacy Address
CVS/SPECIALTY OR CARELONRX SPECIALTY PHA
11162 RENNER BLVD
LENEXA, KS 66219
Pharmacy Comments
Contract Details
Approval Date
5/19/2022
Contract Begin Date
5/20/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Celia Mary Mills, Administrator of Care Coordination and Community Health
(760) 499-3960
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
5/19/2022
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