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CH05099W HEALTHSOURCE OF OHIO, INC. (Active)
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Main Details
Name
HEALTHSOURCE OF OHIO, INC.
Subdivision Name
HealthSource Eastgate Pediatrics
Type
HRSA-Funded Health Center
Site ID
BPS-H80-009189
340B ID
CH05099W
Grant Number
H80CS00201
Additional Details
Current Program Status
Active
Registration Date
8/10/2010
Participating Start Date
10/1/2010
Participating Approval Date
8/10/2010
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
HEALTHSOURCE OF OHIO INC
Sam Rotunna, Vice President, Pharmacy Services
(513) 732-5084
Primary Contact
HEALTHSOURCE OF OHIO INC
Lisa Jackson, VP of Marketing and Development
(513) 576-7700
Addresses
Street Address
4627 Aicholtz Rd.
Cincinnati, OH 45244-1447
Billing Address
HEALTHSOURCE OF OHIO, INC.
424 WARDS CORNER STE 200
LOVELAND, OH 45140-6966
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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5/14/12 - Changed main address from 4357 Ferguson Drive, Suite #150. 3/7/12-Changed contact person (was MISSY HANZEL)
05/14/2012
3/7/12-Changed contact person (was MISSY HANZEL)
03/07/2012
April 2025
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