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KROGER PHARMACY 014411
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
KROGER PHARMACY 014411
Pharmacy Address
824 MAIN STREET
MILFORD, OH 45150
Pharmacy Comments
Contract Details
Approval Date
3/3/2011
Contract Begin Date
3/14/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/11/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
2/23/2011
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