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RITE AID OF OHIO, INC.
RRC360147-00 MARIETTA MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
MARIETTA MEMORIAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360147-00
Entity Address
401 MATTHEW STREET
MARIETTA, OH 45750
Medicare Provider Number
360147
Participating Start Date
1/1/2015
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
RITE AID OF OHIO, INC.
Pharmacy Address
RITE AID #2795
148 NORTH MAIN STREET
WOODSFIELD, OH 43793
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/19/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Doug Full, Director of Finance
(740) 374-1698
Contract Pharmacy Representative
Rite Aid
Charlene Kaiser, VP, Managed Care Operations
(918) 645-6652
Signed By Date
7/17/2023
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