Contract Pharmacy Details

AMC OHIO LLC #2
HV00531 Equitas Health, Inc.

Covered Entity Details

Entity Name

Equitas Health, Inc.

Subdivision Name

Equitas Health Short North

Type

Ryan White Part C

340B ID

HV00531

Entity Address

1033 NORTH HIGH STREET
COLUMBUS, OH 43201

Grant Number

H76HA00531

Participating Start Date

1/1/2013

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

AMC OHIO LLC #2

Pharmacy Address

1222 S. PATTERSON BLVD
SUITE 110
DAYTON, OH 45402-2645

Pharmacy Comments

Contract Details

Approval Date

4/7/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Peggy Anderson, Chief Operating Officer
(614) 340-6691

Contract Pharmacy Representative

Aaron Clark, Director of Pharmacy Services
(614) 340-6776

Signed By Date

4/7/2014

340B Drug Pricing Program Database