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GIANT EAGLE PHARMACY #4078
DSH360059 METROHEALTH MEDICAL CENTER
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Covered Entity Details
Entity Name
METROHEALTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360059
Entity Address
2500 MetroHealth Drive
CLEVELAND, OH 44109-1900
Medicare Provider Number
360059
Participating Start Date
1/1/1994
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #4078
Pharmacy Address
5220 MAHONING AVE
YOUNGSTOWN, OH 44515
Pharmacy Comments
Contract Details
Approval Date
10/7/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/14/2017
Pharmacy closed
Contacts
Covered Entity Signing Official
Michael Stern, SVP, Chief of Staff
(216) 778-5772
Contract Pharmacy Representative
Giant Eagle, Inc.
Mike Bianco, Senior Pharmacy Manager
(412) 967-3718
Signed By Date
10/7/2016
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