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DISCOUNT DRUG MART
CAH361325-15 GALION COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
GALION COMMUNITY HOSPITAL
Subdivision Name
Rural Health Clinic - West 4th Street (RHC 2981) - Internal Med
Type
Critical Access Hospital
340B ID
CAH361325-15
Entity Address
2981 West 4th Street
Ontario, OH 44906
Medicare Provider Number
361325
Outpatient Facility Provider Number
363410
Participating Start Date
4/1/2020
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
DISCOUNT DRUG MART
Pharmacy Address
219 MANSFIELD AVE
SHELBY, OH 44875
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
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