Contract Pharmacy Details

RITE AID OF OHIO, INC.
CAH361325-12 GALION COMMUNITY HOSPITAL

Covered Entity Details

Entity Name

GALION COMMUNITY HOSPITAL

Subdivision Name

Rural Health Clinic - Mansfield Street (RHC 1323) - Family Med

Type

Critical Access Hospital

340B ID

CAH361325-12

Entity Address

1323 E Mansfield Street
Bucyrus, OH 44820

Medicare Provider Number

361325

Outpatient Facility Provider Number

363991

Participating Start Date

1/1/2016

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