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CENTERWELL PHARMACY, INC.
RRC360180-00 CLEVELAND CLINIC HOSPITAL
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Covered Entity Details
Entity Name
CLEVELAND CLINIC HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360180-00
Entity Address
9500 EUCLID AVENUE
CLEVELAND, OH 44195
Medicare Provider Number
360180
Participating Start Date
4/1/2020
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
CENTERWELL PHARMACY, INC.
Pharmacy Address
9843 WINDISCH RD
WEST CHESTER, OH 45069
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/13/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tim Longville, Chief Accounting Officer and Controller
(216) 636-7416
Contract Pharmacy Representative
Centerwell
Shelley Duke, Director, Specialty Pharmacy Contracting and Infusion
(502) 994-8732
Signed By Date
7/14/2020
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