Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
DSH360077 FAIRVIEW HOSPITAL

Covered Entity Details

Entity Name

FAIRVIEW HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH360077

Entity Address

18101 LORAIN AVE
CLEVELAND, OH 44111

Medicare Provider Number

360077

Participating Start Date

7/1/2017

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

OHIO CVS STORES, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03697
19950 DETROIT RD
ROCKY RIVER, OH 44116

Pharmacy Comments

Contract Details

Approval Date

1/14/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Neil P. Smith, President - Fairview Hospital
(216) 476-4499

Contract Pharmacy Representative

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

Signed By Date

1/14/2021

340B Drug Pricing Program Database