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CAREMARK TENNESSEE SPECIALTY PHARMACY, L
DSH260113 MISSOURI DELTA MEDICAL CENTER
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Covered Entity Details
Entity Name
MISSOURI DELTA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260113
Entity Address
1008 NORTH MAIN
SIKESTON, MO 63801
Medicare Provider Number
260113
Participating Start Date
7/1/2006
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
CAREMARK TENNESSEE SPECIALTY PHARMACY, L
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
8370 WOLF LAKE DR
STE 107
BARTLETT, TN 38133
Pharmacy Comments
Contract Details
Approval Date
10/16/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JASON SCHRUMPF, CEO
(573) 472-7600
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/16/2022
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