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PENNSYLVANIA CVS PHARMACY, L.L.C.
CAH391314-00 TITUSVILLE AREA HOSPITAL
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Covered Entity Details
Entity Name
TITUSVILLE AREA HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391314-00
Entity Address
406 WEST OAK STREET
TITUSVILLE, PA 16354
Medicare Provider Number
391314
Participating Start Date
7/1/2015
Last Recertification Date
8/15/2024
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
7/21/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jill A Neely, CFO
(814) 827-8923
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/21/2021
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