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MIAMI VALLEY PHARMACY
CHC26576-01 Five Rivers Health Centers
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Covered Entity Details
Entity Name
Five Rivers Health Centers
Subdivision Name
Five Rivers Medical Surgical Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26576-01
Entity Address
725 South Ludlow
Dayton, OH 45402
Grant Number
H80CS26576
Participating Start Date
10/1/2014
Last Recertification Date
2/9/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
MIAMI VALLEY PHARMACY
Pharmacy Address
ONE WYOMING STREET
DAYTON, OH 45409
Pharmacy Comments
Contract Details
Approval Date
10/1/2014
Contract Begin Date
10/3/2014
Carve-In Effective Date
Contract Comments
10/03/2014 Immediate Begin Date authorized
Contract Termination Date
Termination Reason
1/12/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dave Bridge, CFO
(937) 734-6844
Contract Pharmacy Representative
Robert Bowman, VP of Operations
(937) 208-2184
Signed By Date
10/1/2014
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