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CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
CH100790 LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC
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Covered Entity Details
Entity Name
LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC
Subdivision Name
PHOENIX HEALTH CENTER--LA CLINICA
Type
HRSA-Funded Health Center
340B ID
CH100790
Entity Address
3617 S Pacific Hwy
Medford, OR 97501-8957
Grant Number
H80CS00759
Participating Start Date
1/1/1999
Last Recertification Date
2/12/2025
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
8/24/2022
Contract Begin Date
8/29/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Traci Fossen, Chief Quality Officer
(541) 512-3912
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
8/24/2022
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