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CAREMARK TENNESSEE SPECIALTY PHARMACY, L
DSH100034 MOUNT SINAI MEDICAL CENTER
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Covered Entity Details
Entity Name
MOUNT SINAI MEDICAL CENTER
Subdivision Name
MOUNT SINAI MEDICAL CENTER OF FLORIDA INC.
Type
Disproportionate Share Hospital
340B ID
DSH100034
Entity Address
4300 Alton Road
MIAMI BEACH, FL 33140
Medicare Provider Number
100034
Participating Start Date
4/1/2007
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
CAREMARK TENNESSEE SPECIALTY PHARMACY, L
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
8370 WOLF LAKE DR
STE 107
BARTLETT, TN 38133
Pharmacy Comments
Contract Details
Approval Date
10/6/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/5/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ANGEL PALLIN, SVP OF OPERATIONS
(305) 674-2520
Contract Pharmacy Representative
CVS
JEFF ENGLAND, DIRECTOR
(720) 387-6872
Signed By Date
10/6/2017
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