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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390197 SACRED HEART HOSPITAL
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Covered Entity Details
Entity Name
SACRED HEART HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390197
Entity Address
421 CHEW STREET
ALLENTOWN, PA 18102
Medicare Provider Number
390197
Participating Start Date
7/1/2008
Last Recertification Date
9/10/2020
Entity Termination Date
2/2/2021
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05743
29 WEST 21ST STREET
NORTHAMPTON, PA 18067
Pharmacy Comments
Contract Details
Approval Date
10/7/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/3/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steve Lanshe, Vice president and Chief Legal Council
(610) 776-4502
Contract Pharmacy Representative
CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
10/7/2014
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