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CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
CH03301H THREE LOWER COUNTIES COMMUNITY SERVICES, INC.
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Covered Entity Details
Entity Name
THREE LOWER COUNTIES COMMUNITY SERVICES, INC.
Subdivision Name
THREE LOWER COUNTIES COMMUNITY SVCS INC
Type
HRSA-Funded Health Center
340B ID
CH03301H
Entity Address
12145 Elm St
Princess Anne, MD 21853-1358
Grant Number
H80CS00774
Participating Start Date
4/1/2007
Last Recertification Date
2/10/2025
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
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/2/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Susanne Gray, CEO/President
(410) 749-1015
Contract Pharmacy Representative
CVS
Rick Youngberg, Senior Director, Specialty Product Development
(847) 634-7400
Signed By Date
10/16/2017
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