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THE LANE DRUG COMPANY
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
THE LANE DRUG COMPANY
Pharmacy Address
RITE AID #2320
113 NORTH COUNTYLINE STREET
FOSTORIA, OH 44830
Pharmacy Comments
Contract Details
Approval Date
1/14/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/29/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Russell Wayne Smith, Senior Hospital Administrator
(419) 383-3788
Contract Pharmacy Representative
RITE AID
REBECCA BADDORF, MANAGER, PHARMACEUTICAL REPLENISHMENT PROGRAMS
(717) 214-2518
Signed By Date
1/14/2021
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