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UNIVERSITY HOSPITALS GEAUGA MEDICAL
PED363302-00 UNIVERSITY HOSPITALS RAINBOW BABIES AND CHILDREN'S HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITALS RAINBOW BABIES AND CHILDREN'S HOSPITAL
Subdivision Name
Type
Children's Hospital
340B ID
PED363302-00
Entity Address
11100 EUCLID AVENUE
CLEVELAND, OH 44106
Medicare Provider Number
363302
Participating Start Date
11/13/2009
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
UNIVERSITY HOSPITALS GEAUGA MEDICAL
Pharmacy Address
CENTER OUTPATIENT PHARMACY
13207 RAVENNA ROAD
OUTPATIENT PHARMACY
CHARDON, OH 44024
Pharmacy Comments
Contract Details
Approval Date
10/7/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/13/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael R. Vehovec, Corporate Controller
(216) 767-8729
Contract Pharmacy Representative
UHHS
HENRY BURGESS, VP
(216) 765-2795
Signed By Date
10/7/2021
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