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CLEVELAND CLINIC SPECIALTY/HOME DELIVERY
DSH360144 SOUTH POINTE HOSPITAL
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Covered Entity Details
Entity Name
SOUTH POINTE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360144
Entity Address
4110 WARRENSVILLE CENTER ROAD
WARRENSVILLE HEIGHTS, OH 44122
Medicare Provider Number
360144
Participating Start Date
8/14/2020
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
CLEVELAND CLINIC SPECIALTY/HOME DELIVERY
Pharmacy Address
3175 SCIENCE PARK DR STE AC4-B100
BEACHWOOD, OH 44122-7327
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kris Bennett, Chief Operating Officer
(440) 312-2702
Contract Pharmacy Representative
Cleveland Clinic
Donald Carroll, Associate Chief Pharmacy Officer
(216) 374-3584
Signed By Date
7/17/2017
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