Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
RRC360070-00 CLEVELAND CLINIC MERCY HOSPITAL

Covered Entity Details

Entity Name

CLEVELAND CLINIC MERCY HOSPITAL

Subdivision Name

Type

Rural Referral Center

340B ID

RRC360070-00

Entity Address

1320 MERCY DRIVE N.W
CANTON, OH 44708

Medicare Provider Number

360070

Participating Start Date

7/1/2020

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

OHIO CVS STORES, L.L.C.

Pharmacy Address

CVS PHARMACY # 16247
5584 DRESSLER RD NW
NORTH CANTON, OH 44720

Pharmacy Comments

Contract Details

Approval Date

7/7/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/26/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

David K Stewart, SVP / COO / CFO
(330) 489-1007

Contract Pharmacy Representative

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

Signed By Date

7/7/2020

340B Drug Pricing Program Database