Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
DSH360085 THE OHIO STATE UNIVERSITY HOSPITAL

Covered Entity Details

Entity Name

THE OHIO STATE UNIVERSITY HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH360085

Entity Address

410 W. 10th Avenue
COLUMBUS, OH 43210

Medicare Provider Number

360085

Participating Start Date

7/1/2016

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

OHIO CVS STORES, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06163
711 PARK RD.
WORTHINGTON, OH 43085

Pharmacy Comments

Contract Details

Approval Date

10/15/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/3/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Mark Larmore, Chief Financial Officer
(614) 685-9420

Contract Pharmacy Representative

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

Signed By Date

10/15/2020

340B Drug Pricing Program Database