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WAL-MART PHARMACY 10-2115
RRC360070-00 CLEVELAND CLINIC MERCY HOSPITAL
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Covered Entity Details
Entity Name
CLEVELAND CLINIC MERCY HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360070-00
Entity Address
1320 MERCY DRIVE N.W
CANTON, OH 44708
Medicare Provider Number
360070
Participating Start Date
7/1/2020
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2115
Pharmacy Address
231 BLUEBELL DR NW.
NEW PHILADELPHIA, OH 44663
Pharmacy Comments
Contract Details
Approval Date
10/2/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/21/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David K Stewart, SVP / COO / CFO
(330) 489-1007
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/2/2020
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