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OHIO CVS STORES, L.L.C.
FQHCLA346 HIGHLAND HEALTH PROVIDERS CORPORATION
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Covered Entity Details
Entity Name
HIGHLAND HEALTH PROVIDERS CORPORATION
Subdivision Name
Highland Health Providers
Type
Health Center Program Look-Alike
340B ID
FQHCLA346
Entity Address
1487 N. High St.
Suite102
Hillsboro, OH 45133-8496
Grant Number
LALCS00180
Participating Start Date
4/1/2017
Last Recertification Date
2/10/2020
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06105
610 CHERRY ST.
BLANCHESTER, OH 45107
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Meghann Ackley, Chief Financial Officer
(937) 840-6617
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2019
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