Contract Pharmacy Details

PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390256 MILTON S. HERSHEY MEDICAL CENTER

Covered Entity Details

Entity Name

MILTON S. HERSHEY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH390256

Entity Address

500 UNIVERSITY DRIVE
HERSHEY, PA 17033

Medicare Provider Number

390256

Participating Start Date

4/1/2004

Last Recertification Date

9/24/2024

Pharmacy Details

Pharmacy Name

PENNSYLVANIA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01639
105 S. SPORTING HILL RD.
MECHANICSBURG, PA 17050

Pharmacy Comments

Contract Details

Approval Date

10/16/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Paul Swinko, CHIEF FINANCIAL OFFICER
(717) 531-8794

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/16/2017

340B Drug Pricing Program Database