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ReCept Pharmacy #125
CHC08753-05 BUTLER COUNTY COMMUNITY HEALTH CONSORTIUM, INC.
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Covered Entity Details
Entity Name
BUTLER COUNTY COMMUNITY HEALTH CONSORTIUM, INC.
Subdivision Name
Mobile Dental Van
Type
HRSA-Funded Health Center
340B ID
CHC08753-05
Entity Address
Administrative Offices 210 S. Second St,2nd Floor
Hamilton, OH 45011
Grant Number
H80CS08753
Participating Start Date
7/1/2016
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
ReCept Pharmacy #125
Pharmacy Address
5501 S. Halsted Street
Chicago, IL 60621
Pharmacy Comments
Contract Details
Approval Date
5/3/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stephen Joseph Roller, President & CEO
(513) 454-1467
Contract Pharmacy Representative
Encore Pharmacy
SANDRA VALDEZ, 340B Account Manager
(210) 788-9625
Signed By Date
5/3/2022
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