Contract Pharmacy Details

WAL-MART PHARMACY 10-1368
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

WAL-MART PHARMACY 10-1368

Pharmacy Address

11217 STATE ROUTE 41
WEST UNION, OH 45693

Pharmacy Comments

Contract Details

Approval Date

8/31/2012

Contract Begin Date

8/31/2012

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

William Marois, CFO
(513) 576-7700

Contract Pharmacy Representative

WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498

Signed By Date

7/17/2012

340B Drug Pricing Program Database