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AULTMAN EMPLOYEE PHARMACY
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
AULTMAN EMPLOYEE PHARMACY
Pharmacy Address
2600 6TH ST SW
CANTON, OH 44710-1702
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
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
Aultman Employee Pharmacy
Tom Casey, Assistant Manager Retail Pharmacy
(330) 363-5489
Signed By Date
4/14/2021
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