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RITE AID OF OHIO, INC.
CAH361325-04 GALION COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
GALION COMMUNITY HOSPITAL
Subdivision Name
Provider Based Clinic - Hosford Road (PBC 955)
Type
Critical Access Hospital
340B ID
CAH361325-04
Entity Address
955 Hosford Rd
Galion, OH 44833
Medicare Provider Number
361325
Outpatient Facility Provider Number
Participating Start Date
10/1/2013
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
RITE AID OF OHIO, INC.
Pharmacy Address
RITE AID #4010
355 EAST MAIN STREET
LEXINGTON, OH 44904
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
Rite Aid
Charlene Kaiser, VP, Managed Care Operations
(918) 645-6652
Signed By Date
7/13/2022
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