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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH360137 UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER
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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
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02678
1111 PENINSULA DR.
ERIE, PA 16505
Pharmacy Comments
Contract Details
Approval Date
1/5/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anthony James Schillero, Director, Financial Planning and Analysis
(216) 789-0429
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/5/2023
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