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MEDICINE SHOPPE 1088 LLC
CAH361325-01 GALION COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
GALION COMMUNITY HOSPITAL
Subdivision Name
Rural Health Clinic - Seltzer Station (RHC 385) - Family Med
Type
Critical Access Hospital
340B ID
CAH361325-01
Entity Address
385 N. Seltzer Street
Crestline, OH 44827
Medicare Provider Number
361325
Outpatient Facility Provider Number
363986
Participating Start Date
10/1/2013
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
MEDICINE SHOPPE 1088 LLC
Pharmacy Address
345 N SANDUSKY AVE
BUCYRUS, OH 44820
Pharmacy Comments
Contract Details
Approval Date
7/13/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ERIC DRAIME, CHIEF FINANCIAL OFFICER
(419) 468-0501
Contract Pharmacy Representative
Medicine Shoppe 1088 LLC
Tamer Ibrahim, President
(330) 412-7442
Signed By Date
7/13/2022
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