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WAL-MART PHARMACY 10-1441
DSH360003 University of Cincinnati Medical Center LLC
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Covered Entity Details
Entity Name
University of Cincinnati Medical Center LLC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360003
Entity Address
3188 Bellevue Avenue
CINCINNATI, OH 45219
Medicare Provider Number
360003
Participating Start Date
12/1/1992
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1441
Pharmacy Address
5303 BOWEN DRIVE
DEERFIELD TOWNSHIP, OH 45040
Pharmacy Comments
Contract Details
Approval Date
10/24/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RICK HINDS, Executive Vice President and Chief Financial Officer
(513) 585-8720
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/24/2016
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