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GIANT EAGLE PHARMACY #4060
RRC360084-00 AULTMAN HOSPITAL
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Covered Entity Details
Entity Name
AULTMAN HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360084-00
Entity Address
2600 SIXTH STREET SW
CANTON, OH 44710
Medicare Provider Number
360084
Participating Start Date
7/1/2017
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #4060
Pharmacy Address
6493 STRIP AVENUE, NW
NORTH CANTON, OH 44720
Pharmacy Comments
Contract Details
Approval Date
4/6/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/26/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Adam M Luntz, CHIEF FINANCIAL OFFICER
(330) 363-3889 Ext: 0
Contract Pharmacy Representative
GIANT EAGLE
Mike Bianco, President & CEO
(412) 967-3718
Signed By Date
4/6/2021
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