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OHIO CVS STORES, L.L.C.
CH05099AB HEALTHSOURCE OF OHIO, INC.
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Covered Entity Details
Entity Name
HEALTHSOURCE OF OHIO, INC.
Subdivision Name
SBHC-HAMERSVILLE ELEM/MIDDLE SCH
Type
HRSA-Funded Health Center
340B ID
CH05099AB
Entity Address
1950 STREET ROUTE 125
HAMERSVILLE, OH 45130-9501
Grant Number
H80CS00201
Participating Start Date
10/1/2017
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05431
592 WEST PLANE STREET
BETHEL, OH 45106
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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