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THE OHIO STATE UNIVERSITY OUTPATIENT PHA
RWI43210 Ohio State University Physicians, Inc.
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Covered Entity Details
Entity Name
Ohio State University Physicians, Inc.
Subdivision Name
Department of Internal Medicine, Division of Infectious Diseases
Type
Ryan White Part A
340B ID
RWI43210
Entity Address
410 W. 10th Ave
N1139 Doan Hall
Columbus, OH 43210-1240
Grant Number
H89HA25698
Participating Start Date
4/1/2020
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
THE OHIO STATE UNIVERSITY OUTPATIENT PHA
Pharmacy Address
AT THE CCCT
460 W 10TH AVE RM L012
COLUMBUS, OH 43210
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Larmore, Chief Financial Officer
(614) 685-9420
Contract Pharmacy Representative
Ohio State University
Kevin Wolowiec, Associate Director
(614) 685-4188
Signed By Date
4/15/2020
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