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BLAKE PHARMACY
CAH361326-01 ADAMS COUNTY HOSPITAL DBA ADAMS COUNTY REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ADAMS COUNTY HOSPITAL DBA ADAMS COUNTY REGIONAL MEDICAL CENTER
Subdivision Name
Family Medicine Georgetown - Family Medicine
Type
Critical Access Hospital
340B ID
CAH361326-01
Entity Address
900 Mt Orab Pike
Georgetown, OH 45121
Medicare Provider Number
361326
Outpatient Facility Provider Number
363418
Participating Start Date
10/1/2020
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
BLAKE PHARMACY
Pharmacy Address
BLAKE PHARMACY
103 N. MAIN ST.
PEEBLES, OH 45660
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
Pete R Dagenbach, CFO
(937) 386-3007
Contract Pharmacy Representative
Blake Pharmacy
Katie Sheeley, Pharmacist
(937) 587-3100
Signed By Date
10/13/2020
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