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GENOA HEALTHCARE LLC
CAH361323-00 Aultman Orrville Hospital
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Covered Entity Details
Entity Name
Aultman Orrville Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361323-00
Entity Address
832 SOUTH MAIN STREET
ORRVILLE, OH 44667
Medicare Provider Number
361323
Participating Start Date
1/1/2011
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
624 MARKET STREET N, STE 140
CANTON, OH 44702
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rachel Ann Newhouse, Pharmacy Business Coordinator
(330) 363-4790
Contract Pharmacy Representative
Aultman Orrville Hospital
Rachel Ann Newhouse, Pharmacy Business Coordinator
(330) 363-4790
Signed By Date
1/15/2025
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