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KROGER PHARMACY 16506
CAH361316-03 BUCYRUS COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
BUCYRUS COMMUNITY HOSPITAL
Subdivision Name
Provider Based Clinic - (PBC 629)
Type
Critical Access Hospital
340B ID
CAH361316-03
Entity Address
629 North Sandusky Avenue
Bucyrus, OH 44820
Medicare Provider Number
361316
Outpatient Facility Provider Number
Participating Start Date
10/1/2018
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY 16506
Pharmacy Address
210 E. MARY STREET
BUCYRUS, OH 44820
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eric Draime, CFO
(419) 468-0501
Contract Pharmacy Representative
Avita Health System
Christina Barnes, Director of Pharmacy
(419) 468-0541
Signed By Date
1/15/2020
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