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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH330285 STRONG MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
STRONG MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330285
Entity Address
601 Elmwood Avenue
ROCHESTER, NY 14642
Medicare Provider Number
330285
Participating Start Date
10/1/2003
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01679
197 NORTH MAIN STREET
MANSFIELD PLAZA
MANSFIELD, PA 16933
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carrie Fuller Spencer, Chief Financial Officer
(585) 275-3033
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2021
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