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SHRIVERS PHARMACY #8
CAH361330-02 HOCKING VALLEY COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
HOCKING VALLEY COMMUNITY HOSPITAL
Subdivision Name
HVCH OP CIC BLDG - General Surgery Physician Clinic
Type
Critical Access Hospital
340B ID
CAH361330-02
Entity Address
541 State Route 664 N
Logan, OH 43138
Medicare Provider Number
361330
Outpatient Facility Provider Number
Participating Start Date
7/1/2020
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
SHRIVERS PHARMACY #8
Pharmacy Address
21 HOCKING MALL
LOGAN, OH 43138
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Julie E Grow, CFO
(740) 380-8389
Contract Pharmacy Representative
Coler Long Term Care/Shrivers Pharmacies
Greg Paisley, Chief Operating Officer
(740) 454-2086
Signed By Date
4/14/2020
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