Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
DSH360039 GENESIS HEALTHCARE SYSTEM

Covered Entity Details

Entity Name

GENESIS HEALTHCARE SYSTEM

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH360039

Entity Address

2951 MAPLE AVE.
ZANESVILLE, OH 43701-1406

Medicare Provider Number

360039

Participating Start Date

7/1/2007

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

OHIO CVS STORES, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03455
200 SOUTH SECOND STREET
COSHOCTON, OH 43812

Pharmacy Comments

Contract Details

Approval Date

1/14/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Michael Norman, Chief Financial Officer
(740) 454-4773

Contract Pharmacy Representative

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

Signed By Date

1/14/2019

340B Drug Pricing Program Database