340B Drug Pricing Program Database
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AVITA ONTARIO HOSPITAL (Pending)
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Main Details
Name
AVITA ONTARIO HOSPITAL
Subdivision Name
Provider Based Clinic - Richland Mall (PBC 600 - 205)
Type
Disproportionate Share Hospital
Rural
No
340B ID
Medicare Provider Number
360365
Outpatient Facility Provider Number
Additional Details
Current Program Status
Pending
Registration Date
4/15/2025
Participating Start Date
Participating Approval Date
Last Recertification Date
Contacts
Authorizing Official
Avita Health System
ERIC DRAIME, CHIEF FINANCIAL OFFICER
(419) 468-0501
Primary Contact
Avita Health System
Christina Barnes, Director of Pharmacy
(419) 468-0541
Addresses
Street Address
600 Richland Mall, Ste 205
Ontario, OH 44906
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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