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HARNESS HEALTH PHARMACY
DSH360081 MERCY HEALTH - ST. CHARLES HOSPITAL
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Covered Entity Details
Entity Name
MERCY HEALTH - ST. CHARLES HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360081
Entity Address
2600 NAVARRE AVENUE
OREGON, OH 43616
Medicare Provider Number
360081
Participating Start Date
10/1/2015
Last Recertification Date
9/9/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
HARNESS HEALTH PHARMACY
Pharmacy Address
7160 INDUSTRIAL ROW DR
SUITE 330
MASON, OH 45040
Pharmacy Comments
Contract Details
Approval Date
7/19/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mark S. Thompson, CFO - Toledo Region
(419) 251-0755
Contract Pharmacy Representative
Mercy Health Pharmacy
Scott Spille, System Director - Retail Pharmacy
(859) 814-9786
Signed By Date
7/19/2016
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