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CAREMARK NEW JERSEY SPECIALTY PHCY, LLC
FQHCLA334 NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
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Covered Entity Details
Entity Name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Subdivision Name
Washington Heights
Type
Health Center Program Look-Alike
340B ID
FQHCLA334
Entity Address
600 W 168th St
New York, NY 10032-3702
Grant Number
LALCS00169
Participating Start Date
7/1/2015
Last Recertification Date
1/31/2017
Entity Termination Date
4/1/2018
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
7/11/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/27/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
CVS HEALTH
Joan O'Rourke, VP Specialty Program Management
(847) 559-5282
Signed By Date
7/11/2017
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