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UH AMHERST RETAIL PHARMACY
DSH360137 UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360137
Entity Address
11100 EUCLID AVE.
CLEVELAND, OH 44106
Medicare Provider Number
360137
Participating Start Date
7/1/2004
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
UH AMHERST RETAIL PHARMACY
Pharmacy Address
917 N LAKE ST STE 150
AMHERST, OH 44001
Pharmacy Comments
Contract Details
Approval Date
1/8/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tricia L Bires, Vice President, Treasury
(216) 767-8708
Contract Pharmacy Representative
University Hospitals
Kevin Cunningham, Dir of Pharmacy
(216) 765-2785
Signed By Date
1/8/2025
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