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MEDICINE CENTER PHARMACY
CAH361323-00 Aultman Orrville Hospital
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Covered Entity Details
Entity Name
Aultman Orrville Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361323-00
Entity Address
832 SOUTH MAIN STREET
ORRVILLE, OH 44667
Medicare Provider Number
361323
Participating Start Date
1/1/2011
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
MEDICINE CENTER PHARMACY
Pharmacy Address
551 W HIGH AVE
NEW PHILADELPHIA, OH 44663-2005
Pharmacy Comments
Contract Details
Approval Date
7/14/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/21/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tyler Lee Immel, Executive Director of Finance
(330) 363-4790
Contract Pharmacy Representative
Aultman Orrville Hospital
Tyler Lee Immel, Executive Director of Finance
(330) 363-4790
Signed By Date
7/14/2022
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