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PACETTI'S APOTHECARY, INC
DSH360051 MIAMI VALLEY HOSPITAL
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Covered Entity Details
Entity Name
MIAMI VALLEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360051
Entity Address
ONE WYOMING STREET
DAYTON, OH 45409
Medicare Provider Number
360051
Participating Start Date
4/1/2005
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
PACETTI'S APOTHECARY, INC
Pharmacy Address
DBA SPRINGBORO PHARMACY
268 W CENTRAL AVE
SPRINGBORO, OH 45066
Pharmacy Comments
Contract Details
Approval Date
7/8/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Scott Andrew Shelton, VP CFO
(937) 499-9989
Contract Pharmacy Representative
Medicine Shoppe
Cindy Pacetti, Owner/President
(937) 748-0555
Signed By Date
7/8/2020
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