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DISCOUNT DRUG MART
SCH360125-00 Ashtabula County Medical Center
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Covered Entity Details
Entity Name
Ashtabula County Medical Center
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH360125-00
Entity Address
2420 Lake Avenue
Ashtabula, OH 44004
Medicare Provider Number
360125
Participating Start Date
1/1/2012
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
DISCOUNT DRUG MART
Pharmacy Address
3032 NORTH RIDGE ROAD EAST
ASHTABULA, OH 44004
Pharmacy Comments
Contract Details
Approval Date
4/23/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald L. Kepner, Chief Financial Officer
(440) 997-6912
Contract Pharmacy Representative
Discount Drug Mart
Pete Ratycz, Vice President of Pharmacy
(330) 725-2340
Signed By Date
4/23/2013
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