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RIVERSIDE MED BLDG PHARMACY
DSH360014 OBLENESS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
OBLENESS MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360014
Entity Address
55 HOSPITAL DRIVE
ATHENS, OH 45701-2345
Medicare Provider Number
360014
Participating Start Date
1/1/2015
Last Recertification Date
8/24/2024
Pharmacy Details
Pharmacy Name
RIVERSIDE MED BLDG PHARMACY
Pharmacy Address
3545 OLENTANGY RIVER RD STE 100
COLUMBUS, OH 43214-3998
Pharmacy Comments
Contract Details
Approval Date
1/13/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/25/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mark Seckinger, President
(740) 592-9292
Contract Pharmacy Representative
OhioHealth
Paul Higginbotham, Director - Pharmacy Services
(614) 533-5262
Signed By Date
1/13/2021
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