Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
CAH361325-07 GALION COMMUNITY HOSPITAL

Covered Entity Details

Entity Name

GALION COMMUNITY HOSPITAL

Subdivision Name

Rural Health Clinic - Seltzer Street (RHC 330)

Type

Critical Access Hospital

340B ID

CAH361325-07

Entity Address

330 N. Seltzer Street
Crestline, OH 44827

Medicare Provider Number

361325

Outpatient Facility Provider Number

363992

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 # 06176
1049 WEST FOURTH STREET
MANSFIELD, OH 44906

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

340B Drug Pricing Program Database