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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390133 LEHIGH VALLEY
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Covered Entity Details
Entity Name
LEHIGH VALLEY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390133
Entity Address
1200 South Cedar Crest Boulevard
ALLENTOWN, PA 18103-4000
Medicare Provider Number
390133
Participating Start Date
1/1/2023
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02020
728 UNION BOULEVARD
ALLENTOWN, PA 18109
Pharmacy Comments
Contract Details
Approval Date
11/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/27/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Thomas Marchozzi, Executive Vice President & Chief Financial Officer
(484) 862-3943
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/12/2022
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