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CAREMARK FLORIDA SPECIALTY PHARMACY LLC
DSH050696 Keck Hospital of USC
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Covered Entity Details
Entity Name
Keck Hospital of USC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050696
Entity Address
1500 SAN PABLO STREET
LOS ANGELES, CA 90033
Medicare Provider Number
050696
Participating Start Date
4/1/2010
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
CAREMARK FLORIDA SPECIALTY PHARMACY LLC
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
7930 WOODLAND CENTER BLVD STE 500
TAMPA, FL 33614
Pharmacy Comments
Contract Details
Approval Date
7/17/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rod Hanners, Chief Operating Officer
(323) 442-8677
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/17/2015
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