340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
CAH361301-03 Community Memorial Hospital (Terminated)
Print
Main Details
Name
Community Memorial Hospital
Subdivision Name
COMMUNITY MEMORIAL HOSPITAL - Family Practice
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH361301-03
Medicare Provider Number
361301
Outpatient Facility Provider Number
363421
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2020
Participating Start Date
1/1/2021
Participating Approval Date
10/23/2020
Last Recertification Date
8/16/2023
Termination Date
Termination Reason
10/1/2024
Failure to recertify
Contacts
Authorizing Official
Community Memorial Hospital
Benjamin Sheperd, Director of Pharmacy
(567) 239-1476
Primary Contact
Community Memorial Hospital
Kristi Stull, Controller
(419) 542-6692 Ext: 5659
Addresses
Street Address
107 BUFFALO STREET
ANTWERP, OH 45813
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
June 2025
June 2025
week
S
M
T
W
T
F
S
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
24
8
9
10
11
12
13
14
25
15
16
17
18
19
20
21
26
22
23
24
25
26
27
28
27
29
30
1
2
3
4
5
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session