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CAREMARK, L.L.C.
RRC360084-00 AULTMAN HOSPITAL
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Covered Entity Details
Entity Name
AULTMAN HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360084-00
Entity Address
2600 SIXTH STREET SW
CANTON, OH 44710
Medicare Provider Number
360084
Participating Start Date
7/1/2017
Last Recertification Date
8/26/2024
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
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Adam M Luntz, CHIEF FINANCIAL OFFICER
(330) 363-3889 Ext: 0
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/11/2023
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