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CAMERON MEDICAL OUTREACH
CAH151315-00 CAMERON MEMORIAL COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
CAMERON MEMORIAL COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151315-00
Entity Address
416 EAST MAUMEE STREET
ANGOLA, IN 46703-2015
Medicare Provider Number
151315
Participating Start Date
1/1/2014
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
CAMERON MEDICAL OUTREACH
Pharmacy Address
DBA CAMERON RETAIL PHARMACY
306 E MAUMEE ST STE 106
ANGOLA, IN 46703-2038
Pharmacy Comments
Contract Details
Approval Date
1/3/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Doug Bomba, CFO
(260) 667-5133
Contract Pharmacy Representative
Cameron Memorial Community Hospital, Inc.
Jonathan Crabill, Pharmacy Director
(260) 667-5427
Signed By Date
1/3/2020
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