Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
RRC360180-00 CLEVELAND CLINIC HOSPITAL

Covered Entity Details

Entity Name

CLEVELAND CLINIC HOSPITAL

Subdivision Name

Type

Rural Referral Center

340B ID

RRC360180-00

Entity Address

9500 EUCLID AVENUE
CLEVELAND, OH 44195

Medicare Provider Number

360180

Participating Start Date

4/1/2020

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

OHIO CVS STORES, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03032
4961 MONTICELLO BLVD,
RICHMOND HEIGHTS, OH 44143

Pharmacy Comments

Contract Details

Approval Date

4/13/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Tim Longville, Chief Accounting Officer and Controller
(216) 636-7416

Contract Pharmacy Representative

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

Signed By Date

4/13/2022

340B Drug Pricing Program Database