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OHIO CVS STORES, L.L.C.
RWI43210 Ohio State University Physicians, Inc.
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Covered Entity Details
Entity Name
Ohio State University Physicians, Inc.
Subdivision Name
Department of Internal Medicine, Division of Infectious Diseases
Type
Ryan White Part A
340B ID
RWI43210
Entity Address
410 W. 10th Ave
N1139 Doan Hall
Columbus, OH 43210-1240
Grant Number
H89HA25698
Participating Start Date
4/1/2020
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05715
3355 EAST LIVINGSTON AVE
COLUMBUS, OH 43227
Pharmacy Comments
Contract Details
Approval Date
1/20/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Vincent P Tammaro, Chief Financial Officer
(614) 685-9420
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/20/2023
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