Contract Pharmacy Details

THE LANE DRUG COMPANY
CAH361316-04 BUCYRUS COMMUNITY HOSPITAL

Covered Entity Details

Entity Name

BUCYRUS COMMUNITY HOSPITAL

Subdivision Name

Provider Based Clinic - Hill Street (PBC 124) - Physician Practice

Type

Critical Access Hospital

340B ID

CAH361316-04

Entity Address

124 Hill Street
Bucyrus, OH 44820

Medicare Provider Number

361316

Outpatient Facility Provider Number

Participating Start Date

4/1/2020

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

THE LANE DRUG COMPANY

Pharmacy Address

RITE AID #2394
145 WEST MAIN STREET
CRESTLINE, OH 44827

Pharmacy Comments

Contract Details

Approval Date

7/13/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/1/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Eric Draime, CFO
(419) 468-0501

Contract Pharmacy Representative

Rite Aid
Charlene Kaiser, VP, Managed Care Operations
(918) 645-6652

Signed By Date

7/13/2022

340B Drug Pricing Program Database