Contract Pharmacy Details

OHIO CVS STORES, L.L.C.
CH05099AD HEALTHSOURCE OF OHIO, INC.

Covered Entity Details

Entity Name

HEALTHSOURCE OF OHIO, INC.

Subdivision Name

Healthsource Batavia Ob/Gyn

Type

HRSA-Funded Health Center

340B ID

CH05099AD

Entity Address

2055 Hospital Dr. Ste 220
Batavia, OH 45103-1964

Grant Number

H80CS00201

Participating Start Date

4/1/2018

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

OHIO CVS STORES, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07776
52 W. MAIN ST.
AMELIA, OH 45102

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

340B Drug Pricing Program Database