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PENNSYLVANIA CVS PHARMACY, L.L.C.
RRC390001-00 COMMUNITY MEDICAL CENTER
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Covered Entity Details
Entity Name
COMMUNITY MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC390001-00
Entity Address
1800 MULBERRY STREET
SCRANTON, PA 18510
Medicare Provider Number
390001
Participating Start Date
1/1/2024
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01611
1101 MOOSIC ST.
SCRANTON, PA 18505
Pharmacy Comments
Contract Details
Approval Date
11/27/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ron Beer, Chief Admiistrative Officer
(570) 808-5380
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/17/2023
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