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SHRIVERS PHARMACY #1
RRC360147-00 MARIETTA MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
MARIETTA MEMORIAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360147-00
Entity Address
401 MATTHEW STREET
MARIETTA, OH 45750
Medicare Provider Number
360147
Participating Start Date
1/1/2015
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
SHRIVERS PHARMACY #1
Pharmacy Address
105 N KENNEBEC AVE
MCCONNELSVILLE, OH 43756
Pharmacy Comments
Contract Details
Approval Date
10/11/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Hupp, SR Director of Finance / Interim CFO
(740) 374-1546
Contract Pharmacy Representative
Coler Long Term Care/Shrivers Pharmacies
Greg Paisley, Chief Operating Officer
(740) 454-2086
Signed By Date
10/11/2018
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