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CAREMARK KANSAS SPECIALTY PHARMACY
DSH230207 McLaren Oakland
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Covered Entity Details
Entity Name
McLaren Oakland
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230207
Entity Address
50 NORTH PERRY
PONTIAC, MI 48342
Medicare Provider Number
230207
Participating Start Date
1/1/2005
Last Recertification Date
8/26/2024
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
10/18/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/13/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Matthew LeGault, CFO
(248) 338-5691
Contract Pharmacy Representative
CVS/Caremark
Jason Kwasigroch, Sr. Advisor, Specialty CVS/caremark
(847) 559-5619
Signed By Date
10/18/2016
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