Contract Pharmacy Details

KROGER PHARMACY 014344
CH050990 HEALTHSOURCE OF OHIO, INC.

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 014344

Pharmacy Address

6725 DICK FLYNN BLVD.
GOSHEN, OH 45122

Pharmacy Comments

Contract Details

Approval Date

4/21/2011

Contract Begin Date

4/25/2011

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109

Signed By Date

4/8/2011

340B Drug Pricing Program Database