Contract Pharmacy Details

ADVANCED CARE SCRIPTS, INC
DSH050696 Keck Hospital of USC

Covered Entity Details

Entity Name

Keck Hospital of USC

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050696

Entity Address

1500 SAN PABLO STREET
LOS ANGELES, CA 90033

Medicare Provider Number

050696

Participating Start Date

4/1/2010

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

ADVANCED CARE SCRIPTS, INC

Pharmacy Address

CVS/SPECIALTY OR CARELONRX SPECIALTY PHA
6251 CHANCELLOR DRIVE
SUITE 101
ORLANDO, FL 32809

Pharmacy Comments

Contract Details

Approval Date

4/11/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Rod Hanners, Chief Operating Officer
(323) 442-8677

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/11/2024

340B Drug Pricing Program Database