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BERTRAM RIPLEY PHARMACY
CAH361326-00 ADAMS COUNTY HOSPITAL DBA ADAMS COUNTY REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ADAMS COUNTY HOSPITAL DBA ADAMS COUNTY REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361326-00
Entity Address
230 MEDICAL CENTER DRIVE
SEAMAN, OH 45679
Medicare Provider Number
361326
Participating Start Date
8/13/2010
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
BERTRAM RIPLEY PHARMACY
Pharmacy Address
D.B.A BRISTOW PHARMACY
100 MAIN ST
RIPLEY, OH 45167
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pete R Dagenbach, CFO
(937) 386-3007
Contract Pharmacy Representative
Bertram Georgetown Pharmacy LLC
Alex Bertram, Owner
(859) 948-0275
Signed By Date
4/15/2024
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