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CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
DSH270049 Intermountain Health St Vincent Regional Hospital
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Covered Entity Details
Entity Name
Intermountain Health St Vincent Regional Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH270049
Entity Address
1233 N. 30th Street
Billings, MT 59101
Medicare Provider Number
270049
Participating Start Date
10/1/2012
Last Recertification Date
8/19/2024
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
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen Scremin, Interim CFO
(303) 813-5255
Contract Pharmacy Representative
CVS
Rick Youngberg, Senior Director, Specialty Product Development
(847) 634-7400
Signed By Date
4/17/2017
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