Contract Pharmacy Details

RITE AID OF OHIO, INC.
DSH360076 ATRIUM MEDICAL CENTER

Covered Entity Details

Entity Name

ATRIUM MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH360076

Entity Address

ONE MEDICAL CENTER DRIVE
MIDDLETOWN, OH 45005-1006

Medicare Provider Number

360076

Participating Start Date

10/1/2020

Last Recertification Date

8/23/2024

Pharmacy Details

Pharmacy Name

RITE AID OF OHIO, INC.

Pharmacy Address

RITE AID #1260
1915 CENTRAL AVENUE
MIDDLETOWN, OH 45044

Pharmacy Comments

Contract Details

Approval Date

4/18/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/17/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Craig Allen Ganger, Chief Financial Officer
(937) 499-9988

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

4/18/2021

340B Drug Pricing Program Database