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CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
CH03664C CHASE BREXTON HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
CHASE BREXTON HEALTH SERVICES, INC
Subdivision Name
Chase Brexton Health Services, Inc. at Security Square Center
Type
HRSA-Funded Health Center
340B ID
CH03664C
Entity Address
6901 Security Blvd
Ste 200
Windsor Mill, MD 21244-2412
Grant Number
H80CS00734
Participating Start Date
7/1/2006
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
800 BIERMANN CT STE B
MOUNT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
1/18/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robin Brooks, CFO
(410) 752-0954 Ext: 1148
Contract Pharmacy Representative
CVS
Rick Youngberg, Senior Director, Specialty Product Development
(847) 634-7400
Signed By Date
1/18/2017
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