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OHIO CVS STORES, L.L.C.
CH05711P THIRD STREET COMMUNITY CLINIC INC
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Covered Entity Details
Entity Name
THIRD STREET COMMUNITY CLINIC INC
Subdivision Name
Community Counseling and Wellness Centers-Marion
Type
HRSA-Funded Health Center
340B ID
CH05711P
Entity Address
320 Executive Dr
Marion, OH 43302-6310
Grant Number
H80CS00581
Participating Start Date
1/1/2024
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06176
1049 WEST FOURTH STREET
MANSFIELD, OH 44906
Pharmacy Comments
Contract Details
Approval Date
1/11/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peggy Anderson, CEO
(419) 526-7880
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/11/2024
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