Contract Pharmacy Details

DISCOUNT DRUG MART #79
CAH361325-00 GALION COMMUNITY HOSPITAL

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

DISCOUNT DRUG MART #79

Pharmacy Address

739 CARTER DRIVE
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

Discount Drug Mart
Joseph V Muha, Corporate Counsel/Director of Pharmacy Compliance
(330) 725-2340 Ext: 84480

Signed By Date

7/13/2022

340B Drug Pricing Program Database