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COLLABORATIVE PHARMACY SERVICES
DSH360133 Kettering Health Dayton
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Covered Entity Details
Entity Name
Kettering Health Dayton
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360133
Entity Address
405 W. Grand Avenue
Dayton, OH 45405
Medicare Provider Number
360133
Participating Start Date
7/1/2013
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
COLLABORATIVE PHARMACY SERVICES
Pharmacy Address
4301 LYONS RD
MIAMISBURG, OH 45342
Pharmacy Comments
Contract Details
Approval Date
4/27/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Luis Chanaga, CFO
(937) 723-3414
Contract Pharmacy Representative
Kettering Health Network:Grandview/Kettering/Ft Hamilton/Sycamore/Soin
Linda McCall, Pharmacy Director
(937) 458-4946
Signed By Date
4/27/2018
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