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WAL-MART PHARMACY 10-1333
DSH360085 THE OHIO STATE UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
THE OHIO STATE UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360085
Entity Address
410 W. 10th Avenue
COLUMBUS, OH 43210
Medicare Provider Number
360085
Participating Start Date
7/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1333
Pharmacy Address
301 TOWN CENTER BLVD
VAN WERT, OH 45891
Pharmacy Comments
Contract Details
Approval Date
4/16/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/18/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mark Larmore, Chief Financial Officer
(614) 685-9420
Contract Pharmacy Representative
Walmart
George Flaherty, Senior Director Payer Programs
(479) 204-9374
Signed By Date
4/16/2021
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