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CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
CAN050660-00 USC Norris Cancer Hospital
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Covered Entity Details
Entity Name
USC Norris Cancer Hospital
Subdivision Name
Type
Free Standing Cancer Hospital
340B ID
CAN050660-00
Entity Address
1441 Eastlake Avenue
Los Angeles, CA 90033
Medicare Provider Number
050660
Participating Start Date
1/1/2014
Last Recertification Date
8/22/2024
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
4/18/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rod Hanners, Chief Operating Officer
(323) 442-8677
Contract Pharmacy Representative
CVS
Rick Youngberg, Senior Director, Specialty Product Development
(847) 634-7400
Signed By Date
4/18/2017
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