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RITE AID OF OHIO, INC.
CAH361314-00 H. B. MAGRUDER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
H. B. MAGRUDER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361314-00
Entity Address
615 FULTON STREET
PORT CLINTON, OH 43452
Medicare Provider Number
361314
Participating Start Date
9/23/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
RITE AID OF OHIO, INC.
Pharmacy Address
RITE AID #3179
1626 EAST PERRY STREET
PORT CLINTON, OH 43452
Pharmacy Comments
Contract Details
Approval Date
1/6/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/20/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
NICHOLAS MARSICO, CEO and PRESIDENT
(419) 734-3131
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President, Managed Care
(717) 975-5968
Signed By Date
1/6/2021
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