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OHIO CVS STORES, L.L.C.
DSH360159 ADENA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ADENA REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360159
Entity Address
272 HOSPITAL ROAD
CHILLICOTHE, OH 45601
Medicare Provider Number
360159
Participating Start Date
4/1/2008
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06195
205 EAST MAIN ST
CIRCLEVILLE, OH 43113
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Marie Carlson, CFO
(740) 779-7582
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2019
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