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AULTMAN INFUSION SERVICES
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 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
4/12/2022
Contract Begin Date
4/21/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/22/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tyler Lee Immel, Executive Director of Finance
(330) 363-4790
Contract Pharmacy Representative
Aultman Healthcare Delivery System
Leonard Charles Sedon, Director of Outpatient Pharmacy Services
(330) 363-6039
Signed By Date
4/12/2022
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