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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
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
PRIME THERAPEUTICS SPECIALTY PHARMACY LL
Pharmacy Address
ALLIANCERX WALGREENS PRIME #16568
2354 COMMERCE PARK DRIVE
SUITE 100
ORLANDO, FL 32819-9992
Pharmacy Comments
Contract Details
Approval Date
7/5/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KIM PATTON, CEO
(513) 576-7700
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/5/2017
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