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MORTON'S HILLTOP PHARMACY
FQHCLA396B SHAWNEE MENTAL HEALTH CENTER INC
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Covered Entity Details
Entity Name
SHAWNEE MENTAL HEALTH CENTER INC
Subdivision Name
West Union Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA396B
Entity Address
192 Chestnut Ridge Rd
West Union, OH 45693-9584
Grant Number
LALCS32583
Participating Start Date
10/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MORTON'S HILLTOP PHARMACY
Pharmacy Address
1865 COLES BLVD
PORTSMOUTH, OH 45662
Pharmacy Comments
Contract Details
Approval Date
1/17/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cynthia Holstein, CEO
(740) 442-7670
Contract Pharmacy Representative
Morton's Hilltop Pharmacy
BRETT J. DAVIS, RPH OWNER
(740) 353-1147
Signed By Date
1/17/2024
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