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CAREMARK NEW JERSEY SPECIALTY PHCY, LLC
CARSON TAHOE REGIONAL HEALTHCARE
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Covered Entity Details
Entity Name
CARSON TAHOE REGIONAL HEALTHCARE
Subdivision Name
Type
Sole Community Hospital
340B ID
Entity Address
1600 MEDICAL PARKWAY
CARSON CITY, NV 89702
Medicare Provider Number
290019
Participating Start Date
Last Recertification Date
Pharmacy Details
Pharmacy Name
CAREMARK NEW JERSEY SPECIALTY PHCY, LLC
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
180 PASSAIC AVE UNIT B-5
FAIRFIELD, NJ 07004
Pharmacy Comments
Contract Details
Approval Date
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Katie Kucera, Chief Financial Officer
(775) 445-8000 Ext: 5543
Contract Pharmacy Representative
Signed By Date
10/11/2023
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