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HEALTHSOURCE SEAMAN PHARMACY
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
HEALTHSOURCE SEAMAN PHARMACY
Pharmacy Address
218 STERN DRIVE
SEAMAN, OH 45679
Pharmacy Comments
Contract Details
Approval Date
11/10/2010
Contract Begin Date
12/1/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/11/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
11/1/2010
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