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OHIO CVS STORES, L.L.C.
CAH361325-03 GALION COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
GALION COMMUNITY HOSPITAL
Subdivision Name
Rural Health Clinic - Bucyrus Road (RHC 955)
Type
Critical Access Hospital
340B ID
CAH361325-03
Entity Address
955 Bucyrus Rd
Galion, OH 44833
Medicare Provider Number
361325
Outpatient Facility Provider Number
363987
Participating Start Date
10/1/2013
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03406
101 EAST CHARLES STREET
BUCYRUS, OH 44820
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
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/13/2022
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