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CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
DSH390002 UPMC MCKEESPORT
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Covered Entity Details
Entity Name
UPMC MCKEESPORT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390002
Entity Address
1500 FIFTH AVENUE
MCKEESPORT, PA 15132
Medicare Provider Number
390002
Participating Start Date
4/1/2012
Last Recertification Date
8/28/2024
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
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laurene Timmons, CFO
(412) 664-6781
Contract Pharmacy Representative
CVS
Rick Youngberg, Senior Director, Specialty Product Development
(847) 634-7400
Signed By Date
7/17/2017
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