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OHIO CVS STORES, L.L.C.
STD482161 Health Emergency Lifeline Programs
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Covered Entity Details
Entity Name
Health Emergency Lifeline Programs
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD482161
Entity Address
1726 Howard Street
Detroit, MI 48216-1921
Grant Number
NH25PS005170
Participating Start Date
4/23/2020
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06126
371 LUDLOW AVE.
CINCINNATI, OH 45220
Pharmacy Comments
Contract Details
Approval Date
1/13/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anthony Williams, Chief Executive Officer
(313) 832-3300 Ext: 215
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/13/2022
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