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AZINA, LLC
CAH151305-00 PULASKI MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PULASKI MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151305-00
Entity Address
616 E. 13TH STREET
WINAMAC, IN 46996
Medicare Provider Number
151305
Participating Start Date
8/9/2010
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
AZINA, LLC
Pharmacy Address
5515 PARKCENTER CIR
SUITE 175
DUBLIN, OH 43017
Pharmacy Comments
Contract Details
Approval Date
1/4/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GREGG Alan MALOTT, DIRECTOR OF BUSINESS DEVELOPMENT
(574) 946-2103
Contract Pharmacy Representative
Comprehensive Pharmacy Services
Doug Massey, EVP, Specialty and Ambulatory Operations
(800) 968-6962
Signed By Date
1/4/2024
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