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CAREMARK, L.L.C.
CAH251337-00 TIPPAH COUNTY HOSPITAL
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Covered Entity Details
Entity Name
TIPPAH COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251337-00
Entity Address
1005 City Ave N
RIPLEY, MS 38663
Medicare Provider Number
251337
Participating Start Date
4/1/2019
Last Recertification Date
8/15/2024
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
7/15/2022
Contract Begin Date
7/19/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Patrick Chapman, CEO
(662) 837-9221
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2022
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