340B Drug Pricing Program Database

Pharmacy Name

PENNSYLVANIA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02408
802 N LANSDOWNE AVE
DREXEL HILL, PA 19026

Pharmacy Comments

Approval Date

12/12/2012

Contract Begin Date

1/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2016
Ownership change

Covered Entity Signing Official

Philip J. Ryan, Senior VP & CFO
(610) 338-8228

Contract Pharmacy Representative

Scott Tierney, Senior Director, Payer Relations
(401) 770-2762

Signed By Date

10/12/2012