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OHIO CVS STORES, L.L.C.
DSH360076 ATRIUM MEDICAL CENTER
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Covered Entity Details
Entity Name
ATRIUM MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360076
Entity Address
ONE MEDICAL CENTER DRIVE
MIDDLETOWN, OH 45005-1006
Medicare Provider Number
360076
Participating Start Date
10/1/2020
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY #06138
1205 EAST CENTRAL AVENUE
MIAMISBURG, OH 45342
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
10/13/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Craig Allen Ganger, Chief Financial Officer
(937) 499-9988
Contract Pharmacy Representative
Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118
Signed By Date
10/12/2021
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