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OHIO CVS STORES, L.L.C.
PED363302-00 UNIVERSITY HOSPITALS RAINBOW BABIES AND CHILDREN'S HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITALS RAINBOW BABIES AND CHILDREN'S HOSPITAL
Subdivision Name
Type
Children's Hospital
340B ID
PED363302-00
Entity Address
11100 EUCLID AVENUE
CLEVELAND, OH 44106
Medicare Provider Number
363302
Participating Start Date
11/13/2009
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03343
1491 SOM CENTER RD
MAYFIELD HEIGHTS, OH 44124
Pharmacy Comments
Contract Details
Approval Date
10/5/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael R. Vehovec, Corporate Controller
(216) 767-8729
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/5/2022
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