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NORTHSIDE PAVILION PHARMACY
CH053763J MUSKINGUM VALLEY HEALTH CENTERS
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Covered Entity Details
Entity Name
MUSKINGUM VALLEY HEALTH CENTERS
Subdivision Name
Muskingum Valley Health Centers
Type
HRSA-Funded Health Center
340B ID
CH053763J
Entity Address
440 Browns Ln
Coshocton, OH 43812-2044
Grant Number
H80CS08783
Participating Start Date
7/1/2019
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
NORTHSIDE PAVILION PHARMACY
Pharmacy Address
945 BETHESDA DR
ZANESVILLE, OH 43701-0801
Pharmacy Comments
Contract Details
Approval Date
10/10/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Rebecca F Carr, Chief Financial Officer
(740) 891-9094
Contract Pharmacy Representative
Northside Pharmacy
EJ Stoepfel, Director
(740) 454-5666
Signed By Date
10/10/2019
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