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OHIO CVS STORES, L.L.C.
CH05099AJ HEALTHSOURCE OF OHIO INC
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Covered Entity Details
Entity Name
HEALTHSOURCE OF OHIO INC
Subdivision Name
HealthSource Goshen
Type
HRSA-Funded Health Center
340B ID
CH05099AJ
Entity Address
6696 Goshen Rd. STE 324
Goshen, OH 45122-9273
Grant Number
H80CS00201
Participating Start Date
4/1/2023
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06098
120 E. MAIN STREET
WILMINGTON, OH 45177
Pharmacy Comments
Contract Details
Approval Date
7/9/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Jackson, VP of Marketing and Development
(513) 576-7700
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/9/2024
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