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CLEVELAND CLINIC HOME CARE SERVICES
DSH360077 FAIRVIEW HOSPITAL
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Covered Entity Details
Entity Name
FAIRVIEW HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360077
Entity Address
18101 LORAIN AVE
CLEVELAND, OH 44111
Medicare Provider Number
360077
Participating Start Date
7/1/2017
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
CLEVELAND CLINIC HOME CARE SERVICES
Pharmacy Address
CLEVELAND CLINIC HOME CARE SERVICES
6801 BRECKSVILLE RD STE 10
INDEPENDENCE, OH 44131
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Neil P. Smith, President - Fairview Hospital
(216) 476-4499
Contract Pharmacy Representative
Cleveland Clinic
Donald Carroll, Associate Chief Pharmacy Officer
(216) 374-3584
Signed By Date
10/15/2020
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