Contract Pharmacy Details

KROGER PHARMACY #014447
CH050990 HEALTHSOURCE OF OHIO, INC.

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

KROGER PHARMACY #014447

Pharmacy Address

1425 COLUMBUS AVENUE
LEBANON, OH 45036

Pharmacy Comments

Contract Details

Approval Date

1/6/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

KIM PATTON, CEO
(513) 576-7700

Contract Pharmacy Representative

Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109

Signed By Date

1/6/2020

340B Drug Pricing Program Database