Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
DSH360137 UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH360137

Entity Address

11100 EUCLID AVE.
CLEVELAND, OH 44106

Medicare Provider Number

360137

Participating Start Date

7/1/2004

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

OHIO CVS STORES, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03337
3825 MONTICELLO BLVD
CLEVELAND HEIGHTS, OH 44121

Pharmacy Comments

Contract Details

Approval Date

10/5/2022

Contract Begin Date

1/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/4/2024
Business decision by covered entity and/or pharmacy

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

340B Drug Pricing Program Database