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GIANT EAGLE PHARMACY #4096
DSH360020 SUMMA HEALTH SYSTEM
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Covered Entity Details
Entity Name
SUMMA HEALTH SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360020
Entity Address
525 E. MARKET STREET
AKRON, OH 44309
Medicare Provider Number
360020
Participating Start Date
10/1/2017
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #4096
Pharmacy Address
4300 KENT ROAD
STOW, OH 44224
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas Clifford Deveny, President and CEO
(234) 312-5050
Contract Pharmacy Representative
Giant Eagle, Inc.
Mike Bianco, Senior Pharmacy Manager
(412) 967-3718
Signed By Date
4/14/2020
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