Contract Pharmacy Details

RITE AID OF OHIO, INC.
CAH361325-05 GALION COMMUNITY HOSPITAL

Covered Entity Details

Entity Name

GALION COMMUNITY HOSPITAL

Subdivision Name

Provider Based Clinic - Portland Way (PBC 270A)

Type

Critical Access Hospital

340B ID

CAH361325-05

Entity Address

270 Portland Way South
Suite C
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 #3102
304 HARDING WAY WEST
GALION, OH 44833

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

340B Drug Pricing Program Database