Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
CH048980 LEWIS COUNTY PRIMARY CARE CENTER, INC.

Covered Entity Details

Entity Name

LEWIS COUNTY PRIMARY CARE CENTER, INC.

Subdivision Name

Lewis County Primary Care Center, Inc.

Type

HRSA-Funded Health Center

340B ID

CH048980

Entity Address

211 KY 59
Building A
VANCEBURG, KY 41179

Grant Number

H80CS00106

Participating Start Date

1/1/1999

Last Recertification Date

2/26/2025

Pharmacy Details

Pharmacy Name

OHIO CVS STORES, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07777
2812 SCIOTO TRAIL
PORTSMOUTH, OH 45662

Pharmacy Comments

Contract Details

Approval Date

7/11/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

JERRY UGRIN, CEO
(606) 796-3029

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/11/2017

340B Drug Pricing Program Database