340B Drug Pricing Program Database

Pharmacy Name

FIVE RIVERS HEALTH CENTERS

Pharmacy Address

721 MIAMI CHAPEL RD
DAYTON, OH 45417

Pharmacy Comments

Approval Date

4/24/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/25/2017
Agreement registered in error

Covered Entity Signing Official


Contract Pharmacy Representative

Nicole Crase, Pharmacist
(937) 208-8850

Signed By Date