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OHIO CVS STORES, L.L.C.
CAH181328-00 ARH Mary Breckinridge Health Services, Inc.
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Covered Entity Details
Entity Name
ARH Mary Breckinridge Health Services, Inc.
Subdivision Name
Barbourville ARH Hospital
Type
Critical Access Hospital
340B ID
CAH181328-00
Entity Address
80 HOSPITAL DRIVE
BARBOURVILLE, KY 40906
Medicare Provider Number
181328
Participating Start Date
1/1/2016
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03312
703 W ERVIN ST
VAN WERT, OH 45891
Pharmacy Comments
Contract Details
Approval Date
7/8/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hollie P Harris, President & CEO
(859) 226-2511
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/8/2021
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