Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
CHC12886-00 LOWER LIGHTS CHRISTIAN HEALTH CENTER INC

Covered Entity Details

Entity Name

LOWER LIGHTS CHRISTIAN HEALTH CENTER INC

Subdivision Name

Lower Lights Christian Health Center

Type

HRSA-Funded Health Center

340B ID

CHC12886-00

Entity Address

1160 W Broad St
Columbus, OH 43222-1317

Grant Number

H80CS12886

Participating Start Date

1/1/2011

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

OHIO CVS STORES, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03461
3920 LINDEN AVE.
DAYTON, OH 45432

Pharmacy Comments

Contract Details

Approval Date

7/6/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Tracy Cloud, CEO
(614) 274-1455 Ext: 6000

Contract Pharmacy Representative

Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118

Signed By Date

7/6/2020

340B Drug Pricing Program Database