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CLEVELAND CLINIC HILLCREST AMBULATORY PH
RRC360180-00 CLEVELAND CLINIC HOSPITAL
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Covered Entity Details
Entity Name
CLEVELAND CLINIC HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360180-00
Entity Address
9500 EUCLID AVENUE
CLEVELAND, OH 44195
Medicare Provider Number
360180
Participating Start Date
4/1/2020
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
CLEVELAND CLINIC HILLCREST AMBULATORY PH
Pharmacy Address
6770 MAYFIELD RD.
MAYFIELD HEIGHTS, OH 44124
Pharmacy Comments
Contract Details
Approval Date
4/13/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tim Longville, Chief Accounting Officer and Controller
(216) 636-7416
Contract Pharmacy Representative
Cleveland Clinic
Donald Carroll, Associate Chief Pharmacy Officer
(216) 374-3584
Signed By Date
4/13/2022
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