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OHIO CVS STORES, L.L.C.
CAH361334-00 ADENA PIKE MEDICAL CENTER
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Covered Entity Details
Entity Name
ADENA PIKE MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361334-00
Entity Address
100 DAWN LANE
WAVERLY, OH 45690
Medicare Provider Number
361334
Participating Start Date
1/1/2015
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
CVS/PHARMACY # 11086
210 EAST EMMITT AVE.
WAVERLY, OH 45690
Pharmacy Comments
Contract Details
Approval Date
7/16/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Marie Carlson, CFO
(740) 779-7582
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/16/2021
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