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DAVE'S SUPER MARKET
CH05182D CARE ALLIANCE
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Covered Entity Details
Entity Name
CARE ALLIANCE
Subdivision Name
Mobile Clinic
Type
HRSA-Funded Health Center
340B ID
CH05182D
Entity Address
1530 Saint Clair Ave NE
Cleveland, OH 44114-2004
Grant Number
H80CS00029
Participating Start Date
7/1/2015
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
DAVE'S SUPER MARKET
Pharmacy Address
1929 E 61ST ST.
CLEVELAND, OH 44103-3810
Pharmacy Comments
Contract Details
Approval Date
4/15/2015
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
Contract Pharmacy Representative
Joel Wolfe, Pharmacy Manager
(216) 361-0735
Signed By Date
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