Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
DSH360048 UNIV OF TOLEDO MEDL CENTER

Covered Entity Details

Entity Name

UNIV OF TOLEDO MEDL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH360048

Entity Address

3000 ARLINGTON AVENUE
TOLEDO, OH 43614-2589

Medicare Provider Number

360048

Participating Start Date

4/1/2016

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

OHIO CVS STORES, L.L.C.

Pharmacy Address

CVS/PHARMACY #11155
2104 S. BYRNE ROAD
TOLEDO, OH 43614

Pharmacy Comments

Contract Details

Approval Date

4/13/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Russell Wayne Smith, Senior Hospital Administrator
(419) 383-3788

Contract Pharmacy Representative

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

Signed By Date

4/13/2020

340B Drug Pricing Program Database