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OHIO CVS STORES, L.L.C.
RRC360147-00 MARIETTA MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
MARIETTA MEMORIAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360147-00
Entity Address
401 MATTHEW STREET
MARIETTA, OH 45750
Medicare Provider Number
360147
Participating Start Date
1/1/2015
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03422
131 3RD ST.
MARIETTA, OH 45750
Pharmacy Comments
Contract Details
Approval Date
1/5/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ERIC YOUNG, CFO
(740) 374-1641
Contract Pharmacy Representative
CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
1/5/2015
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