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UNIVERSITY OF TOLEDO
DSH360048 UNIV OF TOLEDO MEDL CENTER
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Covered Entity Details
Entity Name
UNIV OF TOLEDO MEDL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360048
Entity Address
3000 ARLINGTON AVENUE
TOLEDO, OH 43614-2589
Medicare Provider Number
360048
Participating Start Date
4/1/2016
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
UNIVERSITY OF TOLEDO
Pharmacy Address
MEDICAL CENTER PHARMACY
2801 W BANCROFT ST
TOLEDO, OH 43606-3328
Pharmacy Comments
Contract Details
Approval Date
4/5/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ronald Goedde, Finance Officer - Hospital
(419) 383-6376
Contract Pharmacy Representative
Valerie Householder, Outpatient Pharmacy Manager
(419) 530-3471
Signed By Date
4/5/2016
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