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OHIO CVS STORES, L.L.C.
CH05099Q HEALTHSOURCE OF OHIO, INC.
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Covered Entity Details
Entity Name
HEALTHSOURCE OF OHIO, INC.
Subdivision Name
HealthSource Washington Court House
Type
HRSA-Funded Health Center
340B ID
CH05099Q
Entity Address
308 Highland Ave.
Washington Court House, OH 43160
Grant Number
H80CS00201
Participating Start Date
10/1/1998
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03408
1795 COLUMBUS AVENUE
WASHINGTONCOURTHSE, OH 43160
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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