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CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
DSH510013 REYNOLDS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
REYNOLDS MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510013
Entity Address
800 WHEELING AVENUE
GLEN DALE, WV 26038
Medicare Provider Number
510013
Participating Start Date
7/1/2021
Last Recertification Date
8/13/2024
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
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alex Craig Inclan, CFO
(304) 843-3240
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/17/2022
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