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CAREMARK, L.L.C.
RRC150015-00 FRANCISCAN HEALTH MICHIGAN CITY
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Covered Entity Details
Entity Name
FRANCISCAN HEALTH MICHIGAN CITY
Subdivision Name
Type
Rural Referral Center
340B ID
RRC150015-00
Entity Address
3500 Franciscan Way
MICHIGAN CITY, IN 46360
Medicare Provider Number
150015
Participating Start Date
10/1/2019
Last Recertification Date
8/22/2023
Entity Termination Date
10/1/2024
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
4/13/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Amy Herron, Regional CFO
(317) 528-8470
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/13/2023
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