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CAREMARK, L.L.C.
CAH181323-00 Ohio County Hospital
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Covered Entity Details
Entity Name
Ohio County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181323-00
Entity Address
1211 Old Main Street
Hartford, KY 42347-1619
Medicare Provider Number
181323
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
CAREMARK, L.L.C.
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
7251 S. EASTERN AVE.
LAS VEGAS, NV 89119
Pharmacy Comments
Contract Details
Approval Date
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shellie Dube Shouse, CFO
(270) 504-4050
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2021
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