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CAREMARK KANSAS SPECIALTY PHARMACY
RRC300012-00 ELLIOT HOSPITAL
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Covered Entity Details
Entity Name
ELLIOT HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC300012-00
Entity Address
1 ELLIOT WAY
MANCHESTER, NH 03103
Medicare Provider Number
300012
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
CAREMARK KANSAS SPECIALTY PHARMACY
Pharmacy Address
CVS/SPECIALTY OR CARELONRX SPECIALTY PHA
11162 RENNER BLVD
LENEXA, KS 66219
Pharmacy Comments
Contract Details
Approval Date
4/10/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Tate Curti, COO
(603) 663-2082
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/10/2025
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