Contract Pharmacy Details

DBA PROMEDICA SPECIALTY PHARMACY #2
DSH360068 THE TOLEDO HOSPITAL

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

DBA PROMEDICA SPECIALTY PHARMACY #2

Pharmacy Address

TOLEDO HOSPITAL
2109 HUGHES DR
CONRAD JOBST TOWER 840
TOLEDO, OH 43606-3856

Pharmacy Comments

Contract Details

Approval Date

4/15/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/17/2022
OPA Terminated due to audit finding

Contacts

Covered Entity Signing Official

Scott Fought, CFO, Providers, Acute & Ambulatory Care
(567) 585-5909

Contract Pharmacy Representative

ProMedica Health System
Christopher Trimbath, Director 340B Program
(567) 585-1760

Signed By Date

4/15/2014

340B Drug Pricing Program Database