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OHIO CVS STORES, L.L.C.
RRC360065-00 FISHER-TITUS MEDICAL CENTER
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Covered Entity Details
Entity Name
FISHER-TITUS MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360065-00
Entity Address
272 BENEDICT AVE
NORWALK, OH 44857
Medicare Provider Number
360065
Participating Start Date
1/1/2017
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06177
201 WEST MAIN STREET
BELLEVUE, OH 44811
Pharmacy Comments
Contract Details
Approval Date
10/6/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brent W Burkey, MD, President
(440) 660-2550
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/6/2020
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