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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390030 Lehigh Valley Hospital - Schuylkill
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Covered Entity Details
Entity Name
Lehigh Valley Hospital - Schuylkill
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390030
Entity Address
420 South Jackson Street
Pottsville, PA 17901-3625
Medicare Provider Number
390030
Participating Start Date
10/1/2018
Last Recertification Date
8/31/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01323
212 POTTSVILLE ST.
POTTSVILLE, PA 17901
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/4/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stephen Patrick Molitoris, Vice President
(484) 884-0974
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2021
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