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BEAVERCREEK MEDICAL CENTER
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
BEAVERCREEK MEDICAL CENTER
Pharmacy Address
DBA: KETTERING HEALTH PHARMACY - SOIN
3535 PENTAGON BLVD
BEAVERCREEK, OH 45431
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael David Mewhirter, VP of Finance, CFO
(937) 723-3414
Contract Pharmacy Representative
KHN
Kevin Blackburn, Pharmacy Director
(937) 458-4932
Signed By Date
4/15/2019
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