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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390113 Meadville Medical Center
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Covered Entity Details
Entity Name
Meadville Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390113
Entity Address
751 Liberty Street
Meadville, PA 16335
Medicare Provider Number
390113
Participating Start Date
7/1/2013
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05095
124 ERIE ST.
EDINBORO, PA 16412
Pharmacy Comments
Contract Details
Approval Date
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ellie Jo Amory, 340B Program Administrator
(814) 333-5669
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2021
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