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OHIO CVS STORES, L.L.C.
CAH361302-00 TRINITY HOSPITAL TWIN CITY
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Covered Entity Details
Entity Name
TRINITY HOSPITAL TWIN CITY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361302-00
Entity Address
819 N 1st STREET
DENNISON, OH 44621-1003
Medicare Provider Number
361302
Participating Start Date
7/1/2013
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
CVS/PHARMACY # 10961
21 GRANT ST.
DENNISON, OH 44621
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dave Werkin, CFO
(740) 264-8695
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2020
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