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WAL-MART PHARMACY 10-1445
CAH361314-00 H. B. MAGRUDER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
H. B. MAGRUDER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361314-00
Entity Address
615 FULTON STREET
PORT CLINTON, OH 43452
Medicare Provider Number
361314
Participating Start Date
9/23/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1445
Pharmacy Address
2826 E. HARBOR ROAD
PORT CLINTON, OH 43452
Pharmacy Comments
Contract Details
Approval Date
4/11/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
NICHOLAS MARSICO, CEO and PRESIDENT
(419) 734-3131
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/11/2014
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