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DISCOUNT DRUG MART #37
RRC360065-00 FISHER-TITUS MEDICAL CENTER
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Covered Entity Details
Entity Name
FISHER-TITUS MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360065-00
Entity Address
272 BENEDICT AVE
NORWALK, OH 44857
Medicare Provider Number
360065
Participating Start Date
1/1/2017
Last Recertification Date
9/4/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
DISCOUNT DRUG MART #37
Pharmacy Address
84 WHITTLESEY AVE
NORWALK, OH 44857
Pharmacy Comments
Contract Details
Approval Date
10/13/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brent W Burkey, MD, President
(440) 660-2550
Contract Pharmacy Representative
Discount Drug Mart
Pete Ratycz, Vice President of Pharmacy
(330) 725-2340
Signed By Date
10/13/2020
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