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BELMONT COUNTY HEALTH SERVICES, INC.
CAH361302-00 TRINITY HOSPITAL TWIN CITY
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Covered Entity Details
Entity Name
TRINITY HOSPITAL TWIN CITY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361302-00
Entity Address
819 N 1st STREET
DENNISON, OH 44621-1003
Medicare Provider Number
361302
Participating Start Date
7/1/2013
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
BELMONT COUNTY HEALTH SERVICES, INC.
Pharmacy Address
DBA CUSTER PHARMACY
241 S MAIN ST
CADIZ, OH 43907
Pharmacy Comments
Contract Details
Approval Date
1/2/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2024
Ownership change
Contacts
Covered Entity Signing Official
Dave Werkin, CFO
(740) 264-8695
Contract Pharmacy Representative
Harrison Community Hospital
Jason Backel, Owner
(740) 942-2726
Signed By Date
1/2/2019
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