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SHRIVERS PHARMACY AND WELLNESS
DSH360054 HOLZER
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Covered Entity Details
Entity Name
HOLZER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360054
Entity Address
100 JACKSON PIKE
GALLIPOLIS, OH 45631
Medicare Provider Number
360054
Participating Start Date
7/1/2006
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
SHRIVERS PHARMACY AND WELLNESS
Pharmacy Address
310 W UNION ST
SUITE 101
ATHENS, OH 45701-2312
Pharmacy Comments
Contract Details
Approval Date
4/18/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael P Haynes, EVP/CFO
(740) 446-5743
Contract Pharmacy Representative
Shrivers Pharmacy
Ben A Holter, Pharmacy Manager/Partner
(740) 753-2484
Signed By Date
4/18/2018
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