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AZINA, LLC
CAH361314-00 H. B. MAGRUDER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
H. B. MAGRUDER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361314-00
Entity Address
615 FULTON STREET
PORT CLINTON, OH 43452
Medicare Provider Number
361314
Participating Start Date
9/23/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
AZINA, LLC
Pharmacy Address
5515 PARKCENTER CIR
SUITE 175
DUBLIN, OH 43017
Pharmacy Comments
Contract Details
Approval Date
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
NICHOLAS MARSICO, CEO and PRESIDENT
(419) 734-3131
Contract Pharmacy Representative
Comprehensive Pharmacy Services
Doug Massey, EVP, Specialty and Ambulatory Operations
(800) 968-6962
Signed By Date
4/14/2023
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