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CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
PED063301-00 Children's Hospital Colorado
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Covered Entity Details
Entity Name
Children's Hospital Colorado
Subdivision Name
Type
Children's Hospital
340B ID
PED063301-00
Entity Address
13123 EAST 16TH AVENUE
AURORA, CO 80045
Medicare Provider Number
063301
Participating Start Date
9/9/2010
Last Recertification Date
9/4/2024
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
7/26/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jerrod Milton, Senior Vice President Professional & Support Services
(720) 777-2839
Contract Pharmacy Representative
CVS
Rick Youngberg, Senior Director, Specialty Product Development
(847) 634-7400
Signed By Date
7/26/2017
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