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CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
DSH150109 FRANCISCAN HEALTH LAFAYETTE
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Covered Entity Details
Entity Name
FRANCISCAN HEALTH LAFAYETTE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150109
Entity Address
1701 SOUTH CREASY LANE
LAFAYETTE, IN 47905
Medicare Provider Number
150109
Participating Start Date
4/26/2021
Last Recertification Date
8/21/2024
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
4/12/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason Geddes, Regional CFO
(765) 502-4599
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/12/2023
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