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CVS/SPECIALTY OR CARELONRX SPECIALTY PHA
DSH050291 Sutter Bay Hospitals, dba Sutter Santa Rosa Regional Hospital
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Covered Entity Details
Entity Name
Sutter Bay Hospitals, dba Sutter Santa Rosa Regional Hospital
Subdivision Name
dba Sutter Santa Rosa Regional Hospital
Type
Disproportionate Share Hospital
340B ID
DSH050291
Entity Address
30 MARK WEST SPRINGS ROAD
SANTA ROSA, CA 95403
Medicare Provider Number
050291
Participating Start Date
7/1/2005
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
CVS/SPECIALTY OR CARELONRX SPECIALTY PHA
Pharmacy Address
CAREMARK, LLC
1001 SPINKS ROAD, STE 280
FLOWER MOUND, TX 75028
Pharmacy Comments
Contract Details
Approval Date
10/18/2022
Contract Begin Date
11/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dan Peterson, Chief Executive Officer
(707) 576-4564
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/18/2022
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