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CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
RRC150018-00 ELKHART GENERAL HOSPITAL
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Covered Entity Details
Entity Name
ELKHART GENERAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC150018-00
Entity Address
600 EAST BLVD
ELKHART, IN 46514
Medicare Provider Number
150018
Participating Start Date
10/1/2021
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
Pharmacy Address
DBA CVS/CAREMARK 48067
1780 WALL ST
MT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
7/2/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JEFFREY P. COSTELLO, CFO
(574) 647-3549
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/2/2024
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