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CAREMARK, L.L.C.
CH051028A LAKE SUPERIOR COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
LAKE SUPERIOR COMMUNITY HEALTH CENTER
Subdivision Name
LSCHC SUPERIOR CLINIC
Type
HRSA-Funded Health Center
340B ID
CH051028A
Entity Address
2222 E 5th St Bldg
Superior, WI 54880
Grant Number
H80CS00811
Participating Start Date
4/1/2004
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
CAREMARK, L.L.C.
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
7251 S. EASTERN AVE.
LAS VEGAS, NV 89119
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lee Homan, CEO
(218) 336-3503
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2024
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