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CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
DSH490052 RIVERSIDE REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
RIVERSIDE REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490052
Entity Address
500 J Clyde Morris Blvd
NEWPORT NEWS, VA 23601
Medicare Provider Number
490052
Participating Start Date
7/1/2008
Last Recertification Date
8/16/2024
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
7/13/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
WILLIAM W. AUSTIN JR., SENIOR VP & CFO
(757) 534-7015
Contract Pharmacy Representative
CVS HEALTH
Joan O'Rourke, VP Specialty Program Management
(847) 559-5282
Signed By Date
7/13/2017
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