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AMC OHIO LLC #2
HV00531A EQUITAS HEALTH
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Covered Entity Details
Entity Name
EQUITAS HEALTH
Subdivision Name
Type
Ryan White Part C
340B ID
HV00531A
Entity Address
1222 S Patterson Blvd
Suite 230
Dayton, OH 45402
Grant Number
H76HA00531
Participating Start Date
10/1/2014
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
8/15/2014
Contract Begin Date
10/1/2014
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
Contract Pharmacy Representative
Aaron Clark, Director of Pharmacy Services
(614) 340-6776
Signed By Date
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