Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
CHC30718-00 SIGNATURE HEALTH, INC.

Covered Entity Details

Entity Name

SIGNATURE HEALTH, INC.

Subdivision Name

Signature Health, Inc. Administration

Type

HRSA-Funded Health Center

340B ID

CHC30718-00

Entity Address

7232 Justin Way
Mentor, OH 44060-7875

Grant Number

H80CS30718

Participating Start Date

4/1/2017

Last Recertification Date

2/22/2025

Pharmacy Details

Pharmacy Name

OHIO CVS STORES, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07687
20641 FAIRMOUNT BLVD.
SHAKER HEIGHTS, OH 44118

Pharmacy Comments

Contract Details

Approval Date

1/15/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/31/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Jonathan Albert Lee, CEO
(440) 953-9999 Ext: 705133

Contract Pharmacy Representative

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

Signed By Date

1/15/2020

340B Drug Pricing Program Database