Contract Pharmacy Details

HealthSource Mt. Orab Pharmacy
CH05099A HEALTHSOURCE OF OHIO, INC.

Covered Entity Details

Entity Name

HEALTHSOURCE OF OHIO, INC.

Subdivision Name

RIPLEY

Type

HRSA-Funded Health Center

340B ID

CH05099A

Entity Address

14 N 2nd St
Ripley, OH 45167-1101

Grant Number

H80CS00201

Participating Start Date

10/1/1998

Last Recertification Date

1/31/2017

Entity Termination Date

7/1/2017

Pharmacy Details

Pharmacy Name

HealthSource Mt. Orab Pharmacy

Pharmacy Address

150 Health Partners Circle
Mt. Orab, OH 45154

Pharmacy Comments

Contract Details

Approval Date

12/21/2010

Contract Begin Date

12/21/2010

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2017

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

11/1/2010

340B Drug Pricing Program Database