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HARNESS HEALTH PHARMACY
DSH360236 CLERMONT MERCY HOSPITAL
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Covered Entity Details
Entity Name
CLERMONT MERCY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360236
Entity Address
3000 HOSPITAL DRIVE
BATAVIA, OH 45103
Medicare Provider Number
360236
Participating Start Date
7/1/2018
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
HARNESS HEALTH PHARMACY
Pharmacy Address
7160 INDUSTRIAL ROW DR
SUITE 330
MASON, OH 45040
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2024
Ownership change
Contacts
Covered Entity Signing Official
Laura Danielle Thomas, CFO
(513) 624-3282
Contract Pharmacy Representative
Harness Health Pharmacy
Brent Kovalyak, System Director of Pharmacy Operations
(513) 305-6835
Signed By Date
4/16/2018
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