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RIESBECK FOOD MARKETS INC
DSH360080 EAST OHIO REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
EAST OHIO REGIONAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360080
Entity Address
90 NORTH FOURTH STREET
MARTINS FERRY, OH 43935
Medicare Provider Number
360080
Participating Start Date
10/1/2015
Last Recertification Date
8/15/2016
Entity Termination Date
7/1/2017
Pharmacy Details
Pharmacy Name
RIESBECK FOOD MARKETS INC
Pharmacy Address
56130 NATIONAL RD
BRIDGEPORT, OH 43912-1529
Pharmacy Comments
Contract Details
Approval Date
10/14/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Contacts
Covered Entity Signing Official
Lisa M. Simon, Senior Vice President & CFO
(304) 234-8407
Contract Pharmacy Representative
Rita Kelley, Pharmacy Program Director
(740) 695-7050 Ext: 149
Signed By Date
10/14/2015
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