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DAVE'S SUPER MARKET
CH05182B CARE ALLIANCE
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Covered Entity Details
Entity Name
CARE ALLIANCE
Subdivision Name
RIVERVIEW TOWERS CLINIC
Type
HRSA-Funded Health Center
340B ID
CH05182B
Entity Address
1795 W 25TH ST
CLEVELAND, OH 44113-3112
Grant Number
H80CS00029
Participating Start Date
4/1/2013
Last Recertification Date
2/18/2020
Entity Termination Date
4/1/2021
Pharmacy Details
Pharmacy Name
DAVE'S SUPER MARKET
Pharmacy Address
1929 E 61ST ST.
CLEVELAND, OH 44103-3810
Pharmacy Comments
Contract Details
Approval Date
4/14/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Francis Afram-Gyening, Chief Executive Officer
(216) 781-6228 Ext: 253
Contract Pharmacy Representative
Joel Wolfe, Pharmacy Manager
(216) 361-0735
Signed By Date
4/14/2015
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