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TRIHEALTH PHARMACY SOLUTIONS
DSH360134 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO
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Covered Entity Details
Entity Name
THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360134
Entity Address
375 DIXMYTH AVE
CINCINNATI, OH 45220
Medicare Provider Number
360134
Participating Start Date
4/1/2006
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
TRIHEALTH PHARMACY SOLUTIONS
Pharmacy Address
4623 WESLEY AVE STE N
CINCINNATI, OH 45212
Pharmacy Comments
Contract Details
Approval Date
4/13/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Crofton, Sr. Vice President & CFO
(513) 569-6577
Contract Pharmacy Representative
TriHealth
John Reilly, Pharmacy Manager (Group Health/TPS)
(513) 246-5675
Signed By Date
4/13/2015
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