Contract Pharmacy Details

RITE AID OF OHIO, INC.
CAH361314-00 H. B. MAGRUDER MEMORIAL HOSPITAL

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

RITE AID OF OHIO, INC.

Pharmacy Address

RITE AID #3179
1626 EAST PERRY STREET
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

Contract Termination Date
Termination Reason

10/15/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

NICHOLAS MARSICO, CEO and PRESIDENT
(419) 734-3131

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

4/11/2014

340B Drug Pricing Program Database