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DAVIES PHARMACY
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
DAVIES PHARMACY
Pharmacy Address
2915 TUSCARAWAS ST W
STEVE FETTMAN RPH
CANTON, OH 44708-4607
Pharmacy Comments
Contract Details
Approval Date
7/13/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Adam M Luntz, CHIEF FINANCIAL OFFICER
(330) 363-3889 Ext: 0
Contract Pharmacy Representative
Davies Pharmacy
Steven Fettman, Owner
(330) 454-5151
Signed By Date
7/13/2021
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