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AULTMAN INFUSION SERVICES
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
AULTMAN INFUSION SERVICES
Pharmacy Address
HOME INFUSION PHARMACY
2600 SIXTH ST SW
MAIN BLDG, 1ST FLOOR, EAST WING
CANTON, OH 44710
Pharmacy Comments
Contract Details
Approval Date
4/11/2022
Contract Begin Date
4/21/2022
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
Aultman Healthcare Delivery System
Leonard Charles Sedon, Director of Outpatient Pharmacy Services
(330) 363-6039
Signed By Date
4/11/2022
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