340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVITA ONTARIO PHARMACY
DSH360365 AVITA ONTARIO HOSPITAL
Print
Covered Entity Details
Entity Name
AVITA ONTARIO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360365
Entity Address
715 RICHLAND MALL
ONTARIO, OH 44906
Medicare Provider Number
360365
Participating Start Date
7/1/2024
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
AVITA ONTARIO PHARMACY
Pharmacy Address
600 RICHLAND MALL STE 202A
MANSFIELD, OH 44906
Pharmacy Comments
Contract Details
Approval Date
7/11/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ERIC DRAIME, CHIEF FINANCIAL OFFICER
(419) 468-0501
Contract Pharmacy Representative
Avita Health System
Christina Barnes, Director of Pharmacy
(419) 468-0541
Signed By Date
7/11/2024
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session