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PREMIER HEALTH PHARMACY-UVMC
DSH360174 UPPER VALLEY MEDICAL CENTER
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Covered Entity Details
Entity Name
UPPER VALLEY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360174
Entity Address
3130 N. COUNTY ROAD 25 A
TROY, OH 45373
Medicare Provider Number
360174
Participating Start Date
1/1/2016
Last Recertification Date
11/29/2017
Entity Termination Date
7/1/2018
Pharmacy Details
Pharmacy Name
PREMIER HEALTH PHARMACY-UVMC
Pharmacy Address
3130 N COUNTY ROAD 25A
TROY, OH 45373
Pharmacy Comments
Contract Details
Approval Date
1/8/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Timothy Snider, VP Finance
(937) 440-4558
Contract Pharmacy Representative
Premier Health
Eric Napier, Director of Outpatient Pharmacy
(937) 208-6534
Signed By Date
1/8/2016
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