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HARNESS HEALTH PHARMACY
DSH360276C ST ELIZABETH BOARDMAN HEALTH CTR
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Covered Entity Details
Entity Name
ST ELIZABETH BOARDMAN HEALTH CTR
Subdivision Name
ST. ELIZABETH BOARDMAN WOUND CARE
Type
Disproportionate Share Hospital
340B ID
DSH360276C
Entity Address
8423 MARKET STREET
SUITES 100
BOARDMAN, OH 44512-3603
Medicare Provider Number
360276
Outpatient Facility Provider Number
Participating Start Date
10/1/2017
Last Recertification Date
9/5/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
HARNESS HEALTH PHARMACY
Pharmacy Address
7160 INDUSTRIAL ROW DR
SUITE 330
MASON, OH 45040
Pharmacy Comments
Contract Details
Approval Date
8/7/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/22/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Anthony Seminaro, CFO, Markets
(941) 587-1220
Contract Pharmacy Representative
Mercy Health Pharmacy
Scott Spille, System Director - Retail Pharmacy
(859) 814-9786
Signed By Date
8/7/2017
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