Contract Pharmacy Details

KROGER PHARMACY #014817
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 #014817

Pharmacy Address

1230 ROMBACH AVENUE
WILMINGTON, OH 45177

Pharmacy Comments

Contract Details

Approval Date

1/6/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Kim Patton, President
(513) 576-7700 Ext: 3606

Contract Pharmacy Representative

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

Signed By Date

1/6/2016

340B Drug Pricing Program Database