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CAREMARK KANSAS SPECIALTY PHARMACY
DSH220035 NORTH SHORE MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTH SHORE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220035
Entity Address
81 HIGHLAND AVENUE
SALEM, MA 01970
Medicare Provider Number
220035
Participating Start Date
9/5/2008
Last Recertification Date
9/4/2024
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
10/11/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Charles E Adams, Executive Director, Finance
(978) 354-4000
Contract Pharmacy Representative
North Shore Medical Center
Ralph Michael McHatton, Director Pharmacy
(978) 354-2358
Signed By Date
10/11/2022
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