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MEIJER PHARMACY #107
RRC360360-00 SOIN MEDICAL CENTER
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Covered Entity Details
Entity Name
SOIN MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360360-00
Entity Address
3535 PENTAGON PARK BOULEVARD
BEAVERCREEK, OH 45431
Medicare Provider Number
360360
Participating Start Date
4/1/2021
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
MEIJER PHARMACY #107
Pharmacy Address
3822 COLONEL GLENN HWY
FAIRBORN, OH 45324
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/9/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Wendi Barber, Chief Financial Officer
(937) 395-8520
Contract Pharmacy Representative
Meijer
Kevin Hurn, Dir, Pharmacy Procurement and New Business
(616) 791-5185
Signed By Date
4/14/2021
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