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WAL-MART PHARMACY 10-5471
CAH361325-00 GALION COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
GALION COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361325-00
Entity Address
269 PORTLAND WAY SOUTH
GALION, OH 44833
Medicare Provider Number
361325
Participating Start Date
9/24/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5471
Pharmacy Address
2485 POSSUM RUN ROAD
MANSFIELD (S), OH 44903
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
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/13/2022
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