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HOLZER FAMILY PHARMACY-ATHENS
DSH360054 HOLZER
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Covered Entity Details
Entity Name
HOLZER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360054
Entity Address
100 JACKSON PIKE
GALLIPOLIS, OH 45631
Medicare Provider Number
360054
Participating Start Date
7/1/2006
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
HOLZER FAMILY PHARMACY-ATHENS
Pharmacy Address
2131 E STATE ST
ATHENS, OH 45701-2138
Pharmacy Comments
Contract Details
Approval Date
11/10/2010
Contract Begin Date
11/10/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
11/4/2010
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