Contract Pharmacy Details

NEVADA CVS PHARMACY, L.L.C.
DSH290001 RENOWN REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

RENOWN REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH290001

Entity Address

1155 MILL STREET
RENO, NV 89502-1474

Medicare Provider Number

290001

Participating Start Date

4/1/2009

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

NEVADA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 08792
680 N. MCCARRAN BLVD.
SPARKS, NV 89431

Pharmacy Comments

Contract Details

Approval Date

4/5/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/11/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Dawn Ahner, EVP & Chief Administrative Officer
(775) 982-4404

Contract Pharmacy Representative

John R. Zevzavadjian, Vice President, Managed Care
(401) 770-5503

Signed By Date

4/5/2013

340B Drug Pricing Program Database