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NORTHSIDE MVHC PHARMACY
CH053763A 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
CH053763A
Entity Address
716 ADAIR AVE
ZANESVILLE, OH 43701-2836
Grant Number
H80CS08783
Participating Start Date
4/1/2008
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
NORTHSIDE MVHC PHARMACY
Pharmacy Address
716 ADAIR AVE
ZANESVILLE, OH 43701-2836
Pharmacy Comments
Contract Details
Approval Date
8/25/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2023
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
8/25/2015
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