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PENNSYLVANIA CVS PHARMACY, L.L.C.
CAH391308-00 CORRY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CORRY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391308-00
Entity Address
965 SHAMROCK LANE
CORRY, PA 16407
Medicare Provider Number
391308
Participating Start Date
7/1/2015
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05098
330 W. COLUMBUS AVE.
CORRY, PA 16407
Pharmacy Comments
Contract Details
Approval Date
6/25/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Heller, Chief Financial Officer
(814) 664-4641 Ext: 1040
Contract Pharmacy Representative
CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467
Signed By Date
6/25/2015
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