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FITZGERALD'S PHARMACY
CH050990 HEALTHSOURCE OF OHIO, INC.
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Covered Entity Details
Entity Name
HEALTHSOURCE OF OHIO, INC.
Subdivision Name
HEALTHSOURCE OF OHIO, INC.
Type
HRSA-Funded Health Center
340B ID
CH050990
Entity Address
424 WARDS CORNER STE 200
LOVELAND, OH 45140-6966
Grant Number
H80CS00201
Participating Start Date
10/1/1998
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
FITZGERALD'S PHARMACY
Pharmacy Address
305 W MAIN ST
WILLIAMSBURG, OH 45176-1309
Pharmacy Comments
Contract Details
Approval Date
10/2/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
KIM PATTON, CEO
(513) 576-7700
Contract Pharmacy Representative
Fitzgerald Pharmacy
Mark Fitzgerald, Owner
(513) 734-3784
Signed By Date
10/2/2019
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