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BERTRAM GEORGETOWN PHARMACY LLC
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
BERTRAM GEORGETOWN PHARMACY LLC
Pharmacy Address
D.B.A DONOHOO PHARMACY
114 S MAIN ST
GEORGETOWN, OH 45121
Pharmacy Comments
Contract Details
Approval Date
11/8/2021
Contract Begin Date
11/8/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KIM PATTON, CEO
(513) 576-7700
Contract Pharmacy Representative
Bertram Georgetown Pharmacy LLC
Alex Bertram, Owner
(859) 948-0275
Signed By Date
11/8/2021
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