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HealthSource Mt. Orab Pharmacy
CH05099L HEALTHSOURCE OF OHIO, INC.
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Covered Entity Details
Entity Name
HEALTHSOURCE OF OHIO, INC.
Subdivision Name
HealthSource Batavia Family Practice & Pharmacy
Type
HRSA-Funded Health Center
340B ID
CH05099L
Entity Address
2055 Hospital Dr STE 130
Batavia, OH 45103-1978
Grant Number
H80CS00201
Participating Start Date
10/1/1998
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
HealthSource Mt. Orab Pharmacy
Pharmacy Address
150 Health Partners Circle
Mt. Orab, OH 45154
Pharmacy Comments
Contract Details
Approval Date
11/4/2010
Contract Begin Date
11/10/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/11/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
10/27/2010
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