Contract Pharmacy Details

BERTRAM RIPLEY PHARMACY
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

BERTRAM RIPLEY PHARMACY

Pharmacy Address

D.B.A BRISTOW PHARMACY
100 MAIN ST
RIPLEY, OH 45167

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

340B Drug Pricing Program Database