340B Drug Pricing Program Database

Pharmacy Name

DISCOUNT DRUG MART #43

Pharmacy Address

1155 EAST WYANDOT AVENUE
UPPER SANDUSKY, OH 43351

Pharmacy Comments

Approval Date

10/13/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

TY SHAULL, COO
(419) 294-4991 Ext: 2263

Contract Pharmacy Representative

Discount Drug Mart
Pete Ratycz, Vice President of Pharmacy
(330) 725-2340

Signed By Date

10/13/2015