Contract Pharmacy Details

PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH330090 ARNOT OGDEN MEDICAL CENTER

Covered Entity Details

Entity Name

ARNOT OGDEN MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330090

Entity Address

600 Roe Ave
ELMIRA, NY 14905

Medicare Provider Number

330090

Participating Start Date

10/27/2012

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

PENNSYLVANIA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01608
220 MAIN STREET
WATSONTOWN, PA 17777

Pharmacy Comments

Contract Details

Approval Date

10/7/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/3/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Ron Dokken, Vice President of Clinical Affairs
(607) 737-4152

Contract Pharmacy Representative

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

Signed By Date

10/7/2019

340B Drug Pricing Program Database