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CAREMARK, L.L.C.
DSH020012 FAIRBANKS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
FAIRBANKS MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH020012
Entity Address
1650 COWLES STREET
FAIRBANKS, AK 99701-5998
Medicare Provider Number
020012
Participating Start Date
9/9/2005
Last Recertification Date
8/29/2024
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
9/14/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gary W Roderick, CFO
(907) 458-3310
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2022
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