Contract Pharmacy Details

COLER DRUG NELSONVILLE
RRC360147-00 MARIETTA MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

MARIETTA MEMORIAL HOSPITAL

Subdivision Name

Type

Rural Referral Center

340B ID

RRC360147-00

Entity Address

401 MATTHEW STREET
MARIETTA, OH 45750

Medicare Provider Number

360147

Participating Start Date

1/1/2015

Last Recertification Date

8/21/2024

Pharmacy Details

Pharmacy Name

COLER DRUG NELSONVILLE

Pharmacy Address

DBA: SHRIVERS PHARMACY #4
40 WATKINS ST
NELSONVILLE, OH 45764-1452

Pharmacy Comments

Contract Details

Approval Date

4/15/2020

Contract Begin Date

4/30/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Joseph Hupp, SR Director of Finance / Interim CFO
(740) 374-1546

Contract Pharmacy Representative

Coler Long Term Care/Shrivers Pharmacies
Greg Paisley, Chief Operating Officer
(740) 454-2086

Signed By Date

4/15/2020

340B Drug Pricing Program Database