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CAREMARK, L.L.C.
PED053303-00 RADY CHILDRENS HOSPITAL - SAN DIEGO
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Covered Entity Details
Entity Name
RADY CHILDRENS HOSPITAL - SAN DIEGO
Subdivision Name
Type
Children's Hospital
340B ID
PED053303-00
Entity Address
3020 Children's Way
San Diego, CA 92123-4282
Medicare Provider Number
053303
Participating Start Date
1/1/2015
Last Recertification Date
8/28/2024
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
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Charles Brendan Davis, Interim Chief Operating Officer
(858) 966-4001
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2025
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