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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390163 ARMSTRONG COUNTY MEMORIAL
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Covered Entity Details
Entity Name
ARMSTRONG COUNTY MEMORIAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390163
Entity Address
ONE NOLTE DRIVE
KITTANNING, PA 16201
Medicare Provider Number
390163
Participating Start Date
10/1/2021
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03165
95 FREEPORT ST
NEW KENSINGTON, PA 15068
Pharmacy Comments
Contract Details
Approval Date
4/10/2023
Contract Begin Date
5/2/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew F Kociola, Chief Financial Officer
(724) 543-8618
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/10/2023
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