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WALGREEN CO.
CHC26576-00 Dayton Health Center dba Five Rivers Health Centers
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Covered Entity Details
Entity Name
Dayton Health Center dba Five Rivers Health Centers
Subdivision Name
Five Rivers Health Centers Edgemont Campus
Type
HRSA-Funded Health Center
340B ID
CHC26576-00
Entity Address
721 Miami Chapel Road
Dayton, OH 45417
Grant Number
H80CS26576
Participating Start Date
7/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 01548
5271 SALEM AVENUE
TROTWOOD, OH 45426
Pharmacy Comments
Contract Details
Approval Date
10/1/2014
Contract Begin Date
10/3/2014
Carve-In Effective Date
Contract Comments
10/3/2014 Immediate Begin Date Authorized
Contract Termination Date
Termination Reason
7/27/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Dave Bridge, CFO
(937) 734-6844
Contract Pharmacy Representative
Elizabeth Cervera, 340B Operations Analyst
(847) 964-8159
Signed By Date
10/1/2014
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