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OHIO CVS STORES, L.L.C.
DSH360134 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO
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Covered Entity Details
Entity Name
THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360134
Entity Address
375 DIXMYTH AVE
CINCINNATI, OH 45220
Medicare Provider Number
360134
Participating Start Date
4/1/2006
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06079
921 LILA AVE.
MILFORD, OH 45150
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/3/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Crofton, Sr. Vice President & CFO
(513) 569-6577
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2019
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