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CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
DSH050485 Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center
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Covered Entity Details
Entity Name
Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050485
Entity Address
2801 ATLANTIC AVENUE
LONG BEACH, CA 90806
Medicare Provider Number
050485
Participating Start Date
7/1/2004
Last Recertification Date
8/16/2024
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
4/20/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Yair Katz, Chief Executive MCWH SVP Peds
(562) 933-8008
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/20/2023
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