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TOLEDO CLINIC INC
DSH360107 THE BELLEVUE HOSPITAL
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Covered Entity Details
Entity Name
THE BELLEVUE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360107
Entity Address
1400 W. MAIN ST.
BELLEVUE, OH 44811
Medicare Provider Number
360107
Participating Start Date
1/1/2021
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
TOLEDO CLINIC INC
Pharmacy Address
DBA ADVANCED PHARMACY SERVICES
1200 MEDICAL CENTER PKWY STE 1100
MAUMEE, OH 43537
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/12/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Carrie Leigh Condon, Vice President of Finance / Chief Financial Officer
(419) 483-4040 Ext: 4200
Contract Pharmacy Representative
TOLEDO CLINIC
SAMANTHA RENWAND, PHARMACIST
(419) 479-5605 Ext: 5655
Signed By Date
7/15/2022
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