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AZINA, LLC
DSH150011 MARION GENERAL HOSPITAL, INC.
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Covered Entity Details
Entity Name
MARION GENERAL HOSPITAL, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150011
Entity Address
441 NORTH WABASH AVENUE
MARION, IN 46952
Medicare Provider Number
150011
Participating Start Date
7/1/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
AZINA, LLC
Pharmacy Address
5515 PARKCENTER CIR
SUITE 175
DUBLIN, OH 43017
Pharmacy Comments
Contract Details
Approval Date
1/12/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/22/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
TONY ROBERTS, CFO
(765) 660-7041
Contract Pharmacy Representative
Comprehensive Pharmacy Services
Doug Massey, EVP, Specialty and Ambulatory Operations
(800) 968-6962
Signed By Date
1/12/2024
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