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OHIO CVS STORES, L.L.C.
DSH360068 THE TOLEDO HOSPITAL
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Covered Entity Details
Entity Name
THE TOLEDO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360068
Entity Address
2142 N. COVE BLVD.
TOLEDO, OH 43606
Medicare Provider Number
360068
Participating Start Date
4/1/2007
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
CVS/PHARMACY #11155
2104 S. BYRNE ROAD
TOLEDO, OH 43614
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrew James Hageman, Finance Director
(567) 585-0990
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2024
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