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CLAIRE-FRANCES HEALTH SERVICES
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
CLAIRE-FRANCES HEALTH SERVICES
Pharmacy Address
DBA INFUSION SOLUTIONS
5528 MACCORKLE AVE SE
SUITE 101
CHARLESTON, WV 25304
Pharmacy Comments
Contract Details
Approval Date
1/14/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Agreement registered in error
Contacts
Covered Entity Signing Official
DEAN WRAY, CFO
(740) 356-8540
Contract Pharmacy Representative
Philip Nelson, 340B Program Manager
(606) 325-1115
Signed By Date
1/14/2016
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