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RAINBOW PHARMACY
PED363302-00 UNIVERSITY HOSPITALS RAINBOW BABIES AND CHILDREN'S HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITALS RAINBOW BABIES AND CHILDREN'S HOSPITAL
Subdivision Name
Type
Children's Hospital
340B ID
PED363302-00
Entity Address
11100 EUCLID AVENUE
CLEVELAND, OH 44106
Medicare Provider Number
363302
Participating Start Date
11/13/2009
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
RAINBOW PHARMACY
Pharmacy Address
5805 EUCLID AVE STE P201
CLEVELAND, OH 44103
Pharmacy Comments
Contract Details
Approval Date
4/8/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael R. Vehovec, Corporate Controller
(216) 767-8729
Contract Pharmacy Representative
Rainbow Pharmacy
Victoria Lubarsky, Pharmacist
(216) 675-6640
Signed By Date
4/8/2019
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