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WATERS PHARMACY INC
CH05099G HEALTHSOURCE OF OHIO, INC.
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Covered Entity Details
Entity Name
HEALTHSOURCE OF OHIO, INC.
Subdivision Name
HealthSource Mt. Orab
Type
HRSA-Funded Health Center
340B ID
CH05099G
Entity Address
150 Health Partners Circle
Mt. Orab, OH 45154
Grant Number
H80CS00201
Participating Start Date
10/1/1998
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WATERS PHARMACY INC
Pharmacy Address
DBA BRISTOW PHARMACY
100 MAIN ST
RIPLEY, OH 45167-1232
Pharmacy Comments
5/18/10 UPDATED NAME (WAS DBA BRISTONS PHARMACY)
Contract Details
Approval Date
6/1/2010
Contract Begin Date
6/1/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/22/2022
Ownership change
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
ROBERT C. WATERS, OWNER
(937) 392-1122
Signed By Date
5/6/2010
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