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KROGER PHARMACY 16506
CAH361325-02 GALION COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
GALION COMMUNITY HOSPITAL
Subdivision Name
Rural Health Clinic - Portland Way (RHC 270) - Endocrinology
Type
Critical Access Hospital
340B ID
CAH361325-02
Entity Address
270 Portland Way South
Suite E
Galion, OH 44833
Medicare Provider Number
361325
Outpatient Facility Provider Number
363984
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
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