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AMC OHIO LLC
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
Pharmacy Address
1033 N. HIGH STREET
COLUMBUS, OH 43201-2409
Pharmacy Comments
Contract Details
Approval Date
10/15/2014
Contract Begin Date
1/1/2015
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
Equitas Health
Peggy Anderson, Chief Operating Officer
(614) 340-6691
Signed By Date
10/15/2014
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