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OHIO CVS STORES, L.L.C.
RRC360147-00 MARIETTA MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
MARIETTA MEMORIAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360147-00
Entity Address
401 MATTHEW STREET
MARIETTA, OH 45750
Medicare Provider Number
360147
Participating Start Date
1/1/2015
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06184
555 E. STATE ST.
ATHENS, OH 45701
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Hupp, SR Director of Finance / Interim CFO
(740) 374-1546
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2019
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