Contract Pharmacy Details

CORAM ALTERNATE SITE SERVICES, INC.
DSH360085 THE OHIO STATE UNIVERSITY HOSPITAL

Covered Entity Details

Entity Name

THE OHIO STATE UNIVERSITY HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH360085

Entity Address

410 W. 10th Avenue
COLUMBUS, OH 43210

Medicare Provider Number

360085

Participating Start Date

7/1/2016

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

CORAM ALTERNATE SITE SERVICES, INC.

Pharmacy Address

CORAM CVS/SPECIALTY INFUSION SERVICES
4305 MULHAUSER ROAD
SUITE 1
FAIRFIELD, OH 45014-2263

Pharmacy Comments

Contract Details

Approval Date

7/15/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/10/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Mark Larmore, Chief Financial Officer
(614) 685-9420

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/15/2020

340B Drug Pricing Program Database