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Walgreens #21423
DSH360012 ST. ANN'S HOSP OF COLUMBUS INC,
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Covered Entity Details
Entity Name
ST. ANN'S HOSP OF COLUMBUS INC,
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360012
Entity Address
500 SOUTH CLEVELAND AVE
WESTERVILLE, OH 43081-0000
Medicare Provider Number
360012
Participating Start Date
1/1/2016
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
Walgreens #21423
Pharmacy Address
Walgreens Central Fill #21423
6275 Winchester Blvd
Canal WInchester, OH 43110-6537
Pharmacy Comments
Contract Details
Approval Date
10/5/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nicholas Kreatsoulas, Executive Vice President & Chief Clinical Operations Officer
(614) 546-3266
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/5/2023
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