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KROGER PHARMACY #014468
CH05099AH HEALTHSOURCE OF OHIO INC
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Covered Entity Details
Entity Name
HEALTHSOURCE OF OHIO INC
Subdivision Name
HealthSource Felicity
Type
HRSA-Funded Health Center
340B ID
CH05099AH
Entity Address
105 Market Street STE 100
Felicity, OH 45120-9668
Grant Number
H80CS00201
Participating Start Date
11/29/2022
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #014468
Pharmacy Address
262 W. MAIN STREET
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
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
7/9/2024
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