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HIGHLAND PARK CVS, L.L.C.
DSH360059 METROHEALTH MEDICAL CENTER
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Covered Entity Details
Entity Name
METROHEALTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360059
Entity Address
2500 MetroHealth Drive
CLEVELAND, OH 44109-1900
Medicare Provider Number
360059
Participating Start Date
1/1/1994
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07017
1130 S. VETERANS PKWY
BLOOMINGTON, IL 61704
Pharmacy Comments
Contract Details
Approval Date
4/18/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Stern, SVP, Chief of Staff
(216) 778-5772
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/18/2019
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