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AHSSHC
CAH361302-00 TRINITY HOSPITAL TWIN CITY
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Covered Entity Details
Entity Name
TRINITY HOSPITAL TWIN CITY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361302-00
Entity Address
819 N 1st STREET
DENNISON, OH 44621-1003
Medicare Provider Number
361302
Participating Start Date
7/1/2013
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
AHSSHC
Pharmacy Address
EXPEDIEN RX PHARMACY
5050 WESLEY RD STE 120
APOPKA, FL 32712
Pharmacy Comments
Contract Details
Approval Date
10/11/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/10/2017
Agreement registered in error
Contacts
Covered Entity Signing Official
HALLI SELL, CONTROLLER
(740) 922-7450 Ext: 2180
Contract Pharmacy Representative
Agape
Trenia Yielding, Executive Director
(407) 357-2601
Signed By Date
10/11/2016
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