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WAL-MART PHARMACY 10-2613
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
WAL-MART PHARMACY 10-2613
Pharmacy Address
1875 EAST MANSFIELD
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
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/13/2022
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