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THE PHARMACY COUNTER LLC
DSH360068 THE TOLEDO HOSPITAL
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Covered Entity Details
Entity Name
THE TOLEDO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360068
Entity Address
2142 N. COVE BLVD.
TOLEDO, OH 43606
Medicare Provider Number
360068
Participating Start Date
4/1/2007
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
THE PHARMACY COUNTER LLC
Pharmacy Address
DBA PROMEDICA OUTPATIENT PHARMACY
2142 N COVE BLVD
TOLEDO, OH 43606-3895
Pharmacy Comments
Contract Details
Approval Date
10/11/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott Fought, CFO, Providers, Acute & Ambulatory Care
(567) 585-5909
Contract Pharmacy Representative
ProMedica Health System
Bryan Coehrs, Director of Pharmacy Operations
(419) 460-0202
Signed By Date
10/11/2013
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