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MERCY HEALTH LIMA OUTPATIENT PHARMACY
DSH360066 ST. RITAS MEDICAL CENTER LLC
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Covered Entity Details
Entity Name
ST. RITAS MEDICAL CENTER LLC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360066
Entity Address
730 W MARKET ST
LIMA, OH 45801
Medicare Provider Number
360066
Participating Start Date
10/1/2019
Last Recertification Date
9/8/2020
Entity Termination Date
7/26/2021
Pharmacy Details
Pharmacy Name
MERCY HEALTH LIMA OUTPATIENT PHARMACY
Pharmacy Address
D.B.A MERCY HEALTH - ST. RITA'S OUTPATIE
730 W MARKET ST
LIMA, OH 45801-4602
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/26/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
TIM RIEGER, Regional CFO & VP of Finance
(419) 226-9775
Contract Pharmacy Representative
Mercy Health Pharmacy
Scott Spille, System Director - Retail Pharmacy
(859) 814-9786
Signed By Date
4/15/2020
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