Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
DSH360027 AKRON GENERAL MEDICAL CENTER

Covered Entity Details

Entity Name

AKRON GENERAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH360027

Entity Address

1 AKRON GENERAL AVE
AKRON, OH 44307

Medicare Provider Number

360027

Participating Start Date

7/1/2021

Last Recertification Date

8/22/2023

Entity Termination Date

7/1/2024

Pharmacy Details

Pharmacy Name

OHIO CVS STORES, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04312
1225 CANTON RD
AKRON, OH 44312

Pharmacy Comments

Contract Details

Approval Date

6/2/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/26/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Brian Harte, President
(330) 344-6548

Contract Pharmacy Representative

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

Signed By Date

4/14/2021

340B Drug Pricing Program Database