Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
DSH510012 PLEASANT VALLEY HOSPITAL

Covered Entity Details

Entity Name

PLEASANT VALLEY HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH510012

Entity Address

2520 VALLEY DRIVE
POINT PLEASANT, WV 25550

Medicare Provider Number

510012

Participating Start Date

7/1/2006

Last Recertification Date

8/14/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

OHIO CVS STORES, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02394
1013 WASHINGTON BLVD.
BELPRE, OH 45714

Pharmacy Comments

Contract Details

Approval Date

7/8/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/10/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Craig Gilliland, Chief Financial Officer
(304) 675-4340 Ext: 1398

Contract Pharmacy Representative

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

Signed By Date

7/8/2021

340B Drug Pricing Program Database