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AMC OHIO LLC
RWII43201E EQUITAS HEALTH
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Covered Entity Details
Entity Name
EQUITAS HEALTH
Subdivision Name
PORTSMOUTH OFFICE
Type
Ryan White Part B
340B ID
RWII43201E
Entity Address
1615 Chillicothe Street, Suite A
Portsmouth, OH 45662
Grant Number
X07HA00016
Participating Start Date
1/1/2015
Last Recertification Date
2/17/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
AMC OHIO LLC
Pharmacy Address
1033 N. HIGH STREET
COLUMBUS, OH 43201-2409
Pharmacy Comments
Contract Details
Approval Date
12/10/2014
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
Contract Pharmacy Representative
Equitas Health
Peggy Anderson, Chief Operating Officer
(614) 340-6691
Signed By Date
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