Contract Pharmacy Details

KROGER PHARMACY 16506
CAH361325-01 GALION COMMUNITY HOSPITAL

Covered Entity Details

Entity Name

GALION COMMUNITY HOSPITAL

Subdivision Name

Rural Health Clinic - Seltzer Station (RHC 385) - Family Med

Type

Critical Access Hospital

340B ID

CAH361325-01

Entity Address

385 N. Seltzer Street
Crestline, OH 44827

Medicare Provider Number

361325

Outpatient Facility Provider Number

363986

Participating Start Date

10/1/2013

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

10/13/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

ERIC DRAIME, CHIEF FINANCIAL OFFICER
(419) 468-0501

Contract Pharmacy Representative

Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875

Signed By Date

10/13/2020

340B Drug Pricing Program Database