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DISCOUNT DRUG MART #52
CAH361323-00 Aultman Orrville Hospital
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Covered Entity Details
Entity Name
Aultman Orrville Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361323-00
Entity Address
832 SOUTH MAIN STREET
ORRVILLE, OH 44667
Medicare Provider Number
361323
Participating Start Date
1/1/2011
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
DISCOUNT DRUG MART #52
Pharmacy Address
3015 NORTH WOOSTER AVENUE
DOVER, OH 44622
Pharmacy Comments
Contract Details
Approval Date
4/5/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jonathan Dale Basso, Associate CFO
(330) 684-4763
Contract Pharmacy Representative
Discount Drug Mart
Joseph V Muha, Corporate Counsel/Director of Pharmacy Compliance
(330) 725-2340 Ext: 84480
Signed By Date
4/5/2021
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