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MEIJER STORES LIMITED PARTNERSHIP
DSH360048 UNIV OF TOLEDO MEDL CENTER
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Covered Entity Details
Entity Name
UNIV OF TOLEDO MEDL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360048
Entity Address
3000 ARLINGTON AVENUE
TOLEDO, OH 43614-2589
Medicare Provider Number
360048
Participating Start Date
4/1/2016
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
MEIJER STORES LIMITED PARTNERSHIP
Pharmacy Address
D/B/A MEIJER PHARMACY #463
1515 PROFIT DR.
FORT WAYNE, IN 46808
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/29/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Russell Wayne Smith, Senior Hospital Administrator
(419) 383-3788
Contract Pharmacy Representative
Meijer
Katy Diaz, Pharmacy Business Associate
(616) 791-3127
Signed By Date
10/14/2020
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