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CLEVELAND CLINIC HOME CARE SERVICES
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
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
Contacts
Covered Entity Signing Official
Tim Longville, Chief Accounting Officer and Controller
(216) 636-7416
Contract Pharmacy Representative
Cleveland Clinic
Donald Carroll, Associate Chief Pharmacy Officer
(216) 374-3584
Signed By Date
10/15/2020
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