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PENNSYLVANIA CVS PHARMACY, L.L.C.
CAH391316-00 WELLSBORO
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Covered Entity Details
Entity Name
WELLSBORO
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391316-00
Entity Address
32-36 CENTRAL AVENUE
WELLSBORO, PA 16901
Medicare Provider Number
391316
Participating Start Date
4/1/2017
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01679
197 NORTH MAIN STREET
MANSFIELD PLAZA
MANSFIELD, PA 16933
Pharmacy Comments
Contract Details
Approval Date
1/12/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Roger C Yost, CFO, North-Central PA Region
(570) 321-3175
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/12/2024
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