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OHIO CVS STORES, L.L.C.
RRC360079-00 Kettering Health Main Campus
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Covered Entity Details
Entity Name
Kettering Health Main Campus
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360079-00
Entity Address
3535 SOUTHERN BOULEVARD
KETTERING, OH 45429
Medicare Provider Number
360079
Participating Start Date
7/1/2019
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06143
900 N BROAD STREET
FAIRBORN, OH 45324
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/9/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Wendi Barber, Chief Financial Officer
(937) 395-8520
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/14/2021
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