Contract Pharmacy Details

MARC GLASSMAN
DSH360037 ST. VINCENT CHARITY MEDICAL CENTER

Covered Entity Details

Entity Name

ST. VINCENT CHARITY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH360037

Entity Address

2351 EAST 22ND STREET
CLEVELAND, OH 44115

Medicare Provider Number

360037

Participating Start Date

1/1/2001

Last Recertification Date

9/12/2022

Entity Termination Date

1/1/2023

Pharmacy Details

Pharmacy Name

MARC GLASSMAN

Pharmacy Address

DBA MARC'S PHARMACY
12650 ROCKSIDE RD
GARFIELD HEIGHTS, OH 44125

Pharmacy Comments

Contract Details

Approval Date

7/9/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/29/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

JOAN ROSS, COO
(216) 363-7410

Contract Pharmacy Representative

Kevin Yaugher, President, COO
(216) 265-7700

Signed By Date

7/9/2014

340B Drug Pricing Program Database