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CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
DSH360159 ADENA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ADENA REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360159
Entity Address
272 HOSPITAL ROAD
CHILLICOTHE, OH 45601
Medicare Provider Number
360159
Participating Start Date
4/1/2008
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
800 BIERMANN CT STE B
MOUNT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
10/11/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert M. Rosenberger, CFO
(740) 779-7582
Contract Pharmacy Representative
CVS HEALTH
Joan O'Rourke, VP Specialty Program Management
(847) 559-5282
Signed By Date
10/11/2016
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