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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390184 Highlands Hospital
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Covered Entity Details
Entity Name
Highlands Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390184
Entity Address
401 East Murphy Ave.
Connellsville, PA 15425
Medicare Provider Number
390184
Participating Start Date
7/1/2014
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 17264
120 MATTHEW DR
UNIONTOWN, PA 15401
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John S. Andursky, Chief Executive Officer
(724) 626-2359
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2020
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