Contract Pharmacy Details

CAREMARK, L.L.C.
DSH430016 AVERA MCKENNAN

Covered Entity Details

Entity Name

AVERA MCKENNAN

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH430016

Entity Address

1325 S. CLIFF AVE.
SIOUX FALLS, SD 57105

Medicare Provider Number

430016

Participating Start Date

9/18/2008

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

CAREMARK, L.L.C.

Pharmacy Address

DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
1127 BRYN MAWR AVE
SUITE A
REDLANDS, CA 92374

Pharmacy Comments

Contract Details

Approval Date

1/17/2017

Contract Begin Date

4/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

DAVE KAPASKA, REGIONAL PRESIDENT/CEO
(605) 322-7808

Contract Pharmacy Representative

CVS
Gregory Harrington, Senior Director, Specialty Product Development
(909) 796-7171

Signed By Date

1/17/2017

340B Drug Pricing Program Database