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OHIO CVS STORES, L.L.C.
CH05711N THIRD STREET COMMUNITY CLINIC
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Covered Entity Details
Entity Name
THIRD STREET COMMUNITY CLINIC
Subdivision Name
9th Street Dental
Type
HRSA-Funded Health Center
340B ID
CH05711N
Entity Address
431 E 9th St
Ashland, OH 44805-1903
Grant Number
H80CS00581
Participating Start Date
7/1/2021
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06175
755 ASHLAND ROAD
MANSFIELD, OH 44905
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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