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CAREMARK NORTH CAROLINA SPECIALTY PHARMA
DSH110078 EMORY UNIVERSITY HOSPITAL MIDTOWN
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Covered Entity Details
Entity Name
EMORY UNIVERSITY HOSPITAL MIDTOWN
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110078
Entity Address
550 PEACHTREE STREET, NE
ATLANTA, GA 30308-2209
Medicare Provider Number
110078
Participating Start Date
4/1/2006
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
CAREMARK NORTH CAROLINA SPECIALTY PHARMA
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
10700 WORLD TRADE BLVD STE 110
RALEIGH, NC 27617
Pharmacy Comments
Contract Details
Approval Date
7/17/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/30/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JAMES T. HATCHER Jr., CFO
(404) 686-7519
Contract Pharmacy Representative
Philip Nalaboff, VP Area Specialty Pharmacy
(847) 634-7965
Signed By Date
7/17/2015
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