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CAREMARK MASSACHUSETTS SPECIALTY PHARMAC
DSH100075 ST JOSEPH'S HOSPITAL
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Covered Entity Details
Entity Name
ST JOSEPH'S HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100075
Entity Address
3001 WEST DR. M L KING JR BLVD
TAMPA, FL 33607
Medicare Provider Number
100075
Participating Start Date
4/1/2003
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
CAREMARK MASSACHUSETTS SPECIALTY PHARMAC
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
25 BIRCH STREET, BLDG B, SUITE 100
MILFORD, MA 01757
Pharmacy Comments
Contract Details
Approval Date
10/15/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Carl Tremonti, Chief Financial Officer
(813) 870-4020
Contract Pharmacy Representative
CVS Caremark
Joan O'Rourke, Pharmacy Administrator
(412) 825-8574
Signed By Date
10/15/2015
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