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CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
DSH450010 UNITED REGIONAL HEALTH CARE SYSTEM
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Covered Entity Details
Entity Name
UNITED REGIONAL HEALTH CARE SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450010
Entity Address
1600 ELEVENTH STREET
WICHITA FALLS, TX 76301
Medicare Provider Number
450010
Participating Start Date
1/1/2023
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
Pharmacy Address
DBA CVS/CAREMARK 48067
1780 WALL ST
MT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
10/24/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/15/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert M. Pert, Chief Financial Officer
(940) 764-3023
Contract Pharmacy Representative
CVS
Christian Reed, Sr. Director
(401) 770-2118
Signed By Date
10/10/2022
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