Contract Pharmacy Details

CAREMARK, L.L.C.
RW431112B Mary Hitchcock Memorial Hospital dba Ryan White Program

Covered Entity Details

Entity Name

Mary Hitchcock Memorial Hospital dba Ryan White Program

Subdivision Name

Dartmouth-Hitchcock Manchester, Ryan White Part D

Type

Ryan White Part D

340B ID

RW431112B

Entity Address

100 Hitchcock Way
Manchester, NH 03104

Grant Number

H12HA31112

Participating Start Date

1/1/2019

Last Recertification Date

2/28/2022

Entity Termination Date

4/1/2023

Pharmacy Details

Pharmacy Name

CAREMARK, L.L.C.

Pharmacy Address

DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
7251 S. EASTERN AVE.
LAS VEGAS, NV 89119

Pharmacy Comments

Contract Details

Approval Date

10/20/2022

Contract Begin Date

10/25/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Staci A Hermann, CHIEF PHARMACY OFFICER
(603) 653-3160

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/20/2022

340B Drug Pricing Program Database