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SHRIVERS PHARMACY #1
CAH361330-01 HOCKING VALLEY COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
HOCKING VALLEY COMMUNITY HOSPITAL
Subdivision Name
HVCH Rural Health Clinic - Rural Health Clinic
Type
Critical Access Hospital
340B ID
CAH361330-01
Entity Address
1383 W HUNTER ST
Logan, OH 43138
Medicare Provider Number
361330
Outpatient Facility Provider Number
363424
Participating Start Date
7/1/2020
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
SHRIVERS PHARMACY #1
Pharmacy Address
105 N KENNEBEC AVE
MCCONNELSVILLE, OH 43756
Pharmacy Comments
Contract Details
Approval Date
1/15/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Julie E Grow, CFO
(740) 380-8389
Contract Pharmacy Representative
Hocking Valley Community Hospital
Steffany Loper, Director, Pharmacy Services
(740) 380-8332
Signed By Date
1/15/2024
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