Covered Entity Details

CAH361314-00 H. B. MAGRUDER MEMORIAL HOSPITAL (Active) - information as of 4/30/2025 10:52:25 PM

Main Details

Name

H. B. MAGRUDER MEMORIAL HOSPITAL

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH361314-00

Medicare Provider Number

361314

Additional Details

Current Program Status

Active

Registration Date

9/17/2010

Participating Start Date

9/23/2010

Participating Approval Date

9/23/2010

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Magruder Hospital
NICHOLAS MARSICO, CEO and PRESIDENT
(419) 734-3131

Primary Contact

HB Magruder Memorial Hospital
Stephanie Majercak, Pharmacy Regulatory Analyst
(419) 732-4009 Ext: 6802

Addresses

Street Address

615 FULTON STREET
PORT CLINTON, OH 43452

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Shipping Address 1

Magruder Hospital Outpatient Pharmacy
615 Fulton Street Suite 100
Port Clinton, OH 43452

Shipping Address 2

Magruder Pharmacy at Bassetts
3994 E Harbor Rd
Port Clinton, OH 43452

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/14/2023	07/01/2023	11/09/2023	01/08/2024
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/14/2023	07/01/2023	11/09/2023	01/08/2024
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/06/2023	10/01/2023		10/01/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/14/2023	07/01/2023	11/09/2023	01/08/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/14/2023	07/01/2023	11/09/2023	01/08/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.		PHARMACY 2 BOULDEN CIRCLE SUITE 1	NEW CASTLE	DE	19720	04/14/2023	07/01/2023	11/09/2023	01/08/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/06/2023	10/01/2023		10/01/2023
Contract Detail	AZINA, LLC	5515 PARKCENTER CIR	SUITE 175	DUBLIN	OH	43017	04/14/2023	07/01/2023	03/31/2025	04/04/2025
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/14/2023	07/01/2023	11/09/2023	01/08/2024
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/14/2023	07/01/2023	11/09/2023	01/08/2024
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/14/2023	07/01/2023		07/01/2023
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/14/2023	07/01/2023	11/09/2023	01/08/2024
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	07/10/2021	07/21/2021		07/21/2021
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #3179	1626 EAST PERRY STREET	PORT CLINTON	OH	43452	04/11/2014	07/01/2014	10/15/2015	10/15/2015
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #3179	1626 EAST PERRY STREET	PORT CLINTON	OH	43452	01/06/2021	04/01/2021	08/20/2024	08/26/2024
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	07/10/2021	07/21/2021		07/21/2021
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/10/2020	04/01/2020		04/01/2020
Contract Detail	WAL-MART PHARMACY 10-1445	2826 E. HARBOR ROAD		PORT CLINTON	OH	43452	04/11/2014	07/01/2014		08/10/2015
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/10/2020	04/01/2020		04/01/2020
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/14/2023	07/01/2023		07/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/12/2023	01/01/2024		01/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH361314-01	Child	CAH	H. B. MAGRUDER MEMORIAL HOSPITAL	Magruder Hospital Family Clinic	621 FULTON STREET	PORT CLINTON	OH	Active
CAH361314-02	Child	CAH	H. B. MAGRUDER MEMORIAL HOSPITAL	MAGRUDER HOSPITAL PAIN MANAGEMENT	611 FULTON STREET, SUITE D	PORT CLINTON	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Insert	Change Request		Magruder Pharmacy at Bassetts 3994 E Harbor Rd Port Clinton, OH 43452	1/30/2025 1:34 PM
Details	Last Recertification Date	Update	Recertification	8/21/2023 11:56:08 PM	9/3/2024 2:22:02 PM	9/3/2024 2:22 PM
Contacts	Primary Contact	Update	Change Request	Malacos, Kristy Pharmacy Administrator Magruder Hospital 4197343131-3597	Majercak, Stephanie Pharmacy Regulatory Analyst HB Magruder Memorial Hospital 4197324009-6802	12/11/2023 4:10 PM
Details	Last Recertification Date	Update	Recertification	8/31/2022 12:50:05 PM	8/21/2023 11:56:08 PM	8/21/2023 11:56 PM
Details	Last Recertification Date	Update	Recertification	8/24/2021 8:50:42 AM	8/31/2022 12:50:05 PM	8/31/2022 12:50 PM
Contacts	Authorizing Official	Update	Profile Change Request	MARSICO, NICHOLAS CEO and PRESIDENT Magruder Hospital 4198522724	MARSICO, NICHOLAS CEO and PRESIDENT Magruder Hospital 4197343131	8/24/2022 11:47 AM
Details	Last Recertification Date	Update	Recertification	8/18/2020 10:30:18 AM	8/24/2021 8:50:42 AM	8/24/2021 8:50 AM
Contacts	Authorizing Official	Update	Change Request	Almendinger, Todd J. President/CEO H.B. Magruder Memorial Hospital 4197343131-3100	MARSICO, NICHOLAS CEO and PRESIDENT Magruder Hospital 4198522724	10/8/2020 7:18 AM
Details	Last Recertification Date	Update	Recertification	8/21/2019 8:08:41 AM	8/18/2020 10:30:18 AM	8/18/2020 10:30 AM
Addresses	Shipping Address	Insert	Change Request		Magruder Hospital Outpatient Pharmacy 615 Fulton Street Suite 100 Port Clinton, OH 43452	9/7/2019 7:57 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 4:31:36 PM	8/21/2019 8:08:41 AM	8/21/2019 8:08 AM
Details	Last Recertification Date	Update	Recertification	11/8/2017 11:37:17 AM	8/21/2018 4:31:36 PM	8/21/2018 4:31 PM
Details	Last Recertification Date	Update	Recertification	8/15/2016 12:00:00 AM	11/8/2017 11:37:17 AM	11/8/2017 11:37 AM
Contacts	Authorizing Official	Update		Almendinger, Todd J. President/CEO 4197343131-3100	Almendinger, Todd J. President/CEO H.B. Magruder Memorial Hospital 4197343131-3100	10/10/2017 1:41 PM
Contacts	Primary Contact	Update		Malacos, Kristy Pharmacy Administrator 4197343131-3597	Malacos, Kristy Pharmacy Administrator Magruder Hospital 4197343131-3597	9/19/2017 11:22 AM
Contacts	Primary Contact	Update		ALMENDINGER, TODD VICE PRESIDENT OF FINANCE / CFO 4197324079	Malacos, Kristy Pharmacy Administrator 4197343131-3597	5/19/2017 8:10 AM
Contacts	Authorizing Official	Update		ALMENDINGER, TODD VICE PRESIDENT OF FINANCE / CFO 4197324079	Almendinger, Todd J. President/CEO 4197343131-3100	5/19/2017 8:10 AM
Addresses	Main Address	Insert			615 FULTON STREET PORT CLINTON, OH 43452	5/5/2017 12:00 PM
Details	Last Recertification Date	Update		8/24/2015 12:00:00 AM	8/15/2016 12:00:00 AM	8/15/2016 10:40 AM
Details	Last Recertification Date	Update		8/12/2014 12:00:00 AM	8/24/2015 12:00:00 AM	8/24/2015 10:12 AM
Details	Last Recertification Date	Update		9/9/2013 12:00:00 AM	8/12/2014 12:00:00 AM	8/12/2014 2:18 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/9/2013 12:00:00 AM	9/9/2013 9:16 PM
Contacts	Authorizing Official	Insert			ALMENDINGER, TODD VICE PRESIDENT OF FINANCE / CFO 4197324079	6/14/2012 6:57 AM
Contacts	Primary Contact	Insert			ALMENDINGER, TODD VICE PRESIDENT OF FINANCE / CFO 4197324079	6/14/2012 6:57 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	6/14/2012 6:57 AM
Details	Last Recertification Date	Insert				9/23/2010 3:40 PM
Details	Grant Number	Insert				9/23/2010 3:40 PM
Details	340B ID	Insert			CAH361314-00	9/23/2010 3:40 PM
Details	Is Authorizing Official EHB Data	Insert				9/23/2010 3:40 PM
Dates	Last Date That 340B Drugs Purchased	Insert				9/23/2010 3:40 PM
Details	Medicare Provider Number	Insert			361314	9/23/2010 3:40 PM
Details	Entity Name	Insert			H. B. MAGRUDER MEMORIAL HOSPITAL	9/23/2010 3:40 PM
Details	Program Code	Insert			CAH	9/23/2010 3:40 PM
Details	Entity Subname	Insert				9/23/2010 3:40 PM
Dates	Participating Approval Date	Insert			9/23/2010 12:00:00 AM	9/23/2010 3:40 PM
Details	State	Insert			Active	9/23/2010 3:40 PM
Dates	Registration Date	Insert			9/17/2010 12:00:00 AM	9/23/2010 3:40 PM
Dates	Signed By Date	Insert			9/17/2010 12:00:00 AM	9/23/2010 3:40 PM
Dates	Start Date	Insert			9/23/2010 12:00:00 AM	9/23/2010 3:40 PM
Terminations	Termination Comments	Insert				9/23/2010 3:40 PM
Terminations	Termination Date	Insert				9/23/2010 3:40 PM
Terminations	Termination Effective Date	Insert				9/23/2010 3:40 PM
Terminations	Termination Reason	Insert				9/23/2010 3:40 PM