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OHIO CVS STORES, L.L.C.
CH05166D IRONTON AND LAWRENCE COUNTY AREA COMMUNITY ACTION ORGANIZATION
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Covered Entity Details
Entity Name
IRONTON AND LAWRENCE COUNTY AREA COMMUNITY ACTION ORGANIZATION
Subdivision Name
Ironton Health Care Campus
Type
HRSA-Funded Health Center
340B ID
CH05166D
Entity Address
1408 Campbell Dr
Ironton, OH 45638-2301
Grant Number
H80CS00471
Participating Start Date
4/1/2012
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04400
3066 STATE RT. 160
GALLIPOLIS, OH 45631
Pharmacy Comments
Contract Details
Approval Date
4/9/2020
Contract Begin Date
5/6/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelly Adkins, Chief Financial Officer
(740) 532-3534 Ext: 12004
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/9/2020
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