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PROMEDICA PHARMACY GROUP LLC
DSH360259 BAY PARK COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
BAY PARK COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360259
Entity Address
2801 BAY PARK DRIVE
OREGON, OH 43616
Medicare Provider Number
360259
Participating Start Date
7/1/2023
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
PROMEDICA PHARMACY GROUP LLC
Pharmacy Address
PROMEDICA SPECIALTY PHARMACY
3142 W CENTRAL AVE
TOLEDO, OH 43606
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrew James Hageman, Finance Director
(567) 585-0990
Contract Pharmacy Representative
ProMedica Health System
Bryan Coehrs, Director of Pharmacy Operations
(419) 460-0202
Signed By Date
10/15/2024
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