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GIANT EAGLE SPECIALTY #0232
DSH360008 SOUTHERN OHIO MEDICAL CENTER
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Covered Entity Details
Entity Name
SOUTHERN OHIO MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360008
Entity Address
1805 27TH STREET
PORTSMOUTH, OH 45662
Medicare Provider Number
360008
Participating Start Date
4/1/2005
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
GIANT EAGLE SPECIALTY #0232
Pharmacy Address
600 LINDBERGH DRIVE
SUITE 300
MOON TOWNSHIP, PA 15108
Pharmacy Comments
Contract Details
Approval Date
1/7/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/13/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DEAN WRAY, CFO
(740) 356-8540
Contract Pharmacy Representative
GIANT EAGLE
Mike Bianco, President & CEO
(412) 967-3718
Signed By Date
1/7/2016
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