Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
DSH330090 ARNOT OGDEN MEDICAL CENTER

Covered Entity Details

Entity Name

ARNOT OGDEN MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330090

Entity Address

600 Roe Ave
ELMIRA, NY 14905

Medicare Provider Number

330090

Participating Start Date

10/27/2012

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

OHIO CVS STORES, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04803
8000 EUCLID AVE.
CLEVELAND, OH 44103

Pharmacy Comments

Contract Details

Approval Date

10/6/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Mark Dworsky, Vice President of Clinical Services
(607) 737-4152

Contract Pharmacy Representative

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

Signed By Date

10/6/2021

340B Drug Pricing Program Database