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MERCY HEALTH HOME INFUSION - YOUNGSTOWN
DSH360276 ST ELIZABETH BOARDMAN HEALTH CTR
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Covered Entity Details
Entity Name
ST ELIZABETH BOARDMAN HEALTH CTR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360276
Entity Address
8401 MARKET STREET
Boardman, OH 44512
Medicare Provider Number
360276
Participating Start Date
10/1/2017
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
MERCY HEALTH HOME INFUSION - YOUNGSTOWN
Pharmacy Address
979 TIBBETTS-WICK ROAD
SUITE A
GIRARD, OH 44420
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michelle L Crawford, Market CFO Youngstown
(330) 718-8096
Contract Pharmacy Representative
Bon Secours Mercy Health
James Snyder, Manager Pharmacy Operations
(330) 480-4596
Signed By Date
10/14/2022
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