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GIANT EAGLE PHARMACY #1282
DSH360137 UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360137
Entity Address
11100 EUCLID AVE.
CLEVELAND, OH 44106
Medicare Provider Number
360137
Participating Start Date
7/1/2004
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #1282
Pharmacy Address
8383 TYLER BLVD.
MENTOR, OH 44060
Pharmacy Comments
Contract Details
Approval Date
1/9/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/14/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael R. Vehovec, Corporate Controller
(216) 767-8729
Contract Pharmacy Representative
Giant Eagle, Inc.
Mike Bianco, Senior Pharmacy Manager
(412) 967-3718
Signed By Date
1/9/2020
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