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OHIO CVS STORES, L.L.C.
DSH510007 ST. MARYS MEDICAL CENTER INC.
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Covered Entity Details
Entity Name
ST. MARYS MEDICAL CENTER INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510007
Entity Address
2900 FIRST AVENUE
HUNTINGTON, WV 25702-1241
Medicare Provider Number
510007
Participating Start Date
7/1/2016
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04400
3066 STATE RT. 160
GALLIPOLIS, OH 45631
Pharmacy Comments
Contract Details
Approval Date
4/7/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angela Swearingen, VP Finance/CFO
(304) 526-1224
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/7/2021
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