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CAREMARK TENNESSEE SPECIALTY PHARMACY, L
DSH330127 JACOBI MEDICAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
JACOBI MEDICAL CENTER (NYCHHC)
Subdivision Name
FORMERLY BRONX MUNICIPAL HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH330127
Entity Address
1400 PELHAM PKWY SOUTH
BRONX, NY 10461
Medicare Provider Number
330127
Participating Start Date
12/1/1992
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
CAREMARK TENNESSEE SPECIALTY PHARMACY, L
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
8370 WOLF LAKE DR
STE 107
BARTLETT, TN 38133
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/26/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
CVS HEALTH
Joan O'Rourke, VP Specialty Program Management
(847) 559-5282
Signed By Date
7/17/2017
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