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KROGER PHARMACY #014305
CH050990 HEALTHSOURCE OF OHIO, INC.
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Covered Entity Details
Entity Name
HEALTHSOURCE OF OHIO, INC.
Subdivision Name
HEALTHSOURCE OF OHIO, INC.
Type
HRSA-Funded Health Center
340B ID
CH050990
Entity Address
424 WARDS CORNER STE 200
LOVELAND, OH 45140-6966
Grant Number
H80CS00201
Participating Start Date
10/1/1998
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #014305
Pharmacy Address
4630 AICHOLTZ RD.
CINCINNATI, OH 45244
Pharmacy Comments
Contract Details
Approval Date
4/21/2011
Contract Begin Date
4/25/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/10/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/8/2011
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