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CAREMARK NEW JERSEY SPECIALTY PHCY, LLC
CH03664G CHASE BREXTON HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
CHASE BREXTON HEALTH SERVICES, INC
Subdivision Name
Chase Brexton Health Care Anne Arundel Center
Type
HRSA-Funded Health Center
340B ID
CH03664G
Entity Address
200 Hospital Dr
GLEN BURNIE, MD 21061-3961
Grant Number
H80CS00734
Participating Start Date
1/1/2015
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
CAREMARK NEW JERSEY SPECIALTY PHCY, LLC
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
180 PASSAIC AVE UNIT B-5
FAIRFIELD, NJ 07004
Pharmacy Comments
Contract Details
Approval Date
7/25/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robin Brooks, CFO
(410) 752-0954 Ext: 1148
Contract Pharmacy Representative
CVS
Tony Russo, Senior Director, Specialty Product Development
(973) 461-1550
Signed By Date
7/25/2017
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