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KENTUCKY CENTRAL FILL FACILITY, L-010
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
KENTUCKY CENTRAL FILL FACILITY, L-010
Pharmacy Address
5594 SHEPHERDSVILLE ROAD
LOUISVILLE, KY 40228-1012
Pharmacy Comments
Contract Details
Approval Date
10/8/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/20/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
KIM PATTON, CEO
(513) 576-7700
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/8/2019
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