Contract Pharmacy Details

WALGREEN CO.
CH05099AE HEALTHSOURCE OF OHIO, INC.

Covered Entity Details

Entity Name

HEALTHSOURCE OF OHIO, INC.

Subdivision Name

HealthSource West Clermont

Type

HRSA-Funded Health Center

340B ID

CH05099AE

Entity Address

1341 Clough Pike
Ste 150
Batavia, OH 45103-2503

Grant Number

H80CS00201

Participating Start Date

7/1/2018

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 07489
57 W MAIN STREET
AMELIA, OH 45102-1737

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

340B Drug Pricing Program Database