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GATES PHARMACY
DSH360137 UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360137
Entity Address
11100 EUCLID AVE.
CLEVELAND, OH 44106
Medicare Provider Number
360137
Participating Start Date
7/1/2004
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
GATES PHARMACY
Pharmacy Address
125 E BROAD ST STE 109
ELYRIA, OH 44035-6429
Pharmacy Comments
Contract Details
Approval Date
10/7/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
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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