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THE LANE DRUG COMPANY
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
THE LANE DRUG COMPANY
Pharmacy Address
RITE AID #2403
875 LEXINGTON AVENUE
MANSFIELD, OH 44907
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
7/30/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
ERIC DRAIME, CHIEF FINANCIAL OFFICER
(419) 468-0501
Contract Pharmacy Representative
Rite Aid
Charlene Kaiser, VP, Managed Care Operations
(918) 645-6652
Signed By Date
7/13/2022
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