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OHIO CVS STORES, L.L.C.
DSH360037 ST. VINCENT CHARITY MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. VINCENT CHARITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360037
Entity Address
2351 EAST 22ND STREET
CLEVELAND, OH 44115
Medicare Provider Number
360037
Participating Start Date
1/1/2001
Last Recertification Date
9/12/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04803
8000 EUCLID AVE.
CLEVELAND, OH 44103
Pharmacy Comments
Contract Details
Approval Date
10/30/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/17/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JOAN ROSS, COO
(216) 363-7410
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
10/30/2013
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