Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
RRC360084-00 AULTMAN HOSPITAL

Covered Entity Details

Entity Name

AULTMAN HOSPITAL

Subdivision Name

Type

Rural Referral Center

340B ID

RRC360084-00

Entity Address

2600 SIXTH STREET SW
CANTON, OH 44710

Medicare Provider Number

360084

Participating Start Date

7/1/2017

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

OHIO CVS STORES, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY #2385
1339 NORTH MAIN STREET
NORTH CANTON, OH 44720

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

Adam M Luntz, CHIEF FINANCIAL OFFICER
(330) 363-3889 Ext: 0

Contract Pharmacy Representative

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

Signed By Date

7/14/2021

340B Drug Pricing Program Database