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WALGREEN CO.
DSH360085 THE OHIO STATE UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
THE OHIO STATE UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360085
Entity Address
410 W. 10th Avenue
COLUMBUS, OH 43210
Medicare Provider Number
360085
Participating Start Date
7/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 02127
410 W 10TH AVE
COLUMBUS, OH 43210-1240
Pharmacy Comments
Contract Details
Approval Date
10/15/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/17/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Mark Larmore, Chief Financial Officer
(614) 685-9420
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2017
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