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OHIO CVS STORES, L.L.C.
DSH510055 Cabell Huntington Hospital, Inc.
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Covered Entity Details
Entity Name
Cabell Huntington Hospital, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510055
Entity Address
1340 Hal Greer Blvd.
Huntington, WV 25701-0195
Medicare Provider Number
510055
Participating Start Date
4/1/2005
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06349
1109 IRONTON HILLS DR.
IRONTON, OH 45638
Pharmacy Comments
Contract Details
Approval Date
10/13/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David M Ward, Sr. Vp/Cfo
(304) 526-2055
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
10/13/2020
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