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KROGER PHARMACY 518
CAH361325-08 GALION COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
GALION COMMUNITY HOSPITAL
Subdivision Name
Provider Based Clinic - Portland Way (PBC 269)
Type
Critical Access Hospital
340B ID
CAH361325-08
Entity Address
269 Portland Way South
Galion, OH 44833
Medicare Provider Number
361325
Outpatient Facility Provider Number
Participating Start Date
10/1/2013
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY 518
Pharmacy Address
1240 PARK AVE. WEST
MANSFIELD, OH 44906
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, CHIEF FINANCIAL OFFICER
(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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