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NORTHSIDE MAYSVILLE PHARMACY
CH0537630 MUSKINGUM VALLEY HEALTH CENTERS
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Covered Entity Details
Entity Name
MUSKINGUM VALLEY HEALTH CENTERS
Subdivision Name
Muskingum Valley Health Centers
Type
HRSA-Funded Health Center
340B ID
CH0537630
Entity Address
859 N Main St
Malta, OH 43758-9007
Grant Number
H80CS08783
Participating Start Date
4/1/2008
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
NORTHSIDE MAYSVILLE PHARMACY
Pharmacy Address
15 N MAYSVILLE AVE
ZANESVILLE, OH 43701-6110
Pharmacy Comments
Contract Details
Approval Date
6/15/2012
Contract Begin Date
6/15/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
DAN J ATKINSON, CEO
(740) 891-9090
Contract Pharmacy Representative
Rod Stickrath, Director
(740) 454-5666 Ext: 7014
Signed By Date
6/1/2012
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