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OHIO CVS STORES, L.L.C.
FQHCLA271 FAMILY HEALTH CARE OF NORTHWEST OHIO, INC
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Covered Entity Details
Entity Name
FAMILY HEALTH CARE OF NORTHWEST OHIO, INC
Subdivision Name
Type
Health Center Program Look-Alike
340B ID
FQHCLA271
Entity Address
1052 S Washington St
VAN WERT, OH 45891
Grant Number
LALCS00027
Participating Start Date
1/1/2011
Last Recertification Date
2/9/2015
Entity Termination Date
4/1/2016
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03312
703 W ERVIN ST
VAN WERT, OH 45891
Pharmacy Comments
Contract Details
Approval Date
10/21/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jennifer L Smith, CEO
(419) 238-6747 Ext: 103
Contract Pharmacy Representative
CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467
Signed By Date
10/21/2015
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