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OHIO CVS STORES, L.L.C.
DSH180029 HAZARD ARH REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
HAZARD ARH REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180029
Entity Address
100 MEDICAL CENTER DRIVE
HAZARD, KY 41701
Medicare Provider Number
180029
Participating Start Date
10/1/2004
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05666
1101 BELLEFONTAINE ST.
WAPAKONETA, OH 45895
Pharmacy Comments
Contract Details
Approval Date
1/7/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hollie P Harris, President & CEO
(859) 226-2511
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/7/2022
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