340B Drug Pricing Program Database
COMMCARE PHARMACY-FTL, LLC
DSH360112 MERCY HEALTH - ST. VINCENT MEDICAL CENTER - information as of 5/12/2025 12:29:03 AM
Covered Entity Details
Entity Name
MERCY HEALTH - ST. VINCENT MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360112
Entity Address
2213 CHERRY STREET
TOLEDO, OH 43608
Medicare Provider Number
360112
Participating Start Date
1/1/2005
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
COMMCARE PHARMACY-FTL, LLC
Pharmacy Address
855 SW 78TH AVE STE C100
PLANTATION, FL 33324-3223
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
7/17/2019
Ownership change
Contacts
Covered Entity Signing Official
Donald E. Kline, Chief Financial Officer, Northern Division
(330) 884-7118
Contract Pharmacy Representative
Commcare
Bob Raffalo, VP Specialty Pharmacy Operations
(954) 284-2384
Signed By Date
4/14/2015
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