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WALGREEN CO.
CH05099W HEALTHSOURCE OF OHIO, INC.
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Covered Entity Details
Entity Name
HEALTHSOURCE OF OHIO, INC.
Subdivision Name
HealthSource Eastgate Pediatrics
Type
HRSA-Funded Health Center
340B ID
CH05099W
Entity Address
4627 Aicholtz Rd.
Cincinnati, OH 45244-1447
Grant Number
H80CS00201
Participating Start Date
10/1/2010
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07637
1243 STATE ROUTE 28
MILFORD, OH 45150-2248
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/9/2024
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