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CAREMARK KANSAS SPECIALTY PHARMACY
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 KANSAS SPECIALTY PHARMACY
Pharmacy Address
CVS/SPECIALTY OR CARELONRX SPECIALTY PHA
11162 RENNER BLVD
LENEXA, KS 66219
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
Ron Finch, Senior Director, Specialty Product Development
(913) 748-3200
Signed By Date
7/26/2017
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