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OHIO CVS STORES, L.L.C.
DSH360027 AKRON GENERAL MEDICAL CENTER
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Covered Entity Details
Entity Name
AKRON GENERAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360027
Entity Address
1 AKRON GENERAL AVE
AKRON, OH 44307
Medicare Provider Number
360027
Participating Start Date
7/1/2021
Last Recertification Date
8/22/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03088
473 HIGH STREET
WADSWORTH, OH 44281
Pharmacy Comments
Contract Details
Approval Date
1/12/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brian Harte, President
(330) 344-6548
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/12/2023
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