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Walmart Pharmacy 10-7611
DSH360085 THE OHIO STATE UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
THE OHIO STATE UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360085
Entity Address
410 W. 10th Avenue
COLUMBUS, OH 43210
Medicare Provider Number
360085
Participating Start Date
7/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/18/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Vincent P Tammaro, Chief Financial Officer
(614) 685-9420
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/13/2023
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