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HEALTHSOURCE OF OHIO GOSHEN PHARMACY
CH05099A HEALTHSOURCE OF OHIO, INC.
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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 OF OHIO GOSHEN PHARMACY
Pharmacy Address
1515 STATE ROUTE 28
SUITE C
LOVELAND, OH 45140
Pharmacy Comments
Contract Details
Approval Date
5/2/2011
Contract Begin Date
5/4/2011
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
4/22/2011
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