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CAREY PHARMACY
CAH361329-00 WYANDOT MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
WYANDOT MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361329-00
Entity Address
885 N Sandusky Ave
UPPER SANDUSKY, OH 43351
Medicare Provider Number
361329
Participating Start Date
8/19/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CAREY PHARMACY
Pharmacy Address
235 E NORTH ST
CAREY, OH 43316
Pharmacy Comments
Contract Details
Approval Date
4/2/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/25/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
TY SHAULL, COO
(419) 294-4991 Ext: 2263
Contract Pharmacy Representative
Wyandot Memorial Hospital
Jennifer Peters, PIC
(419) 731-4163
Signed By Date
4/2/2024
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