Contract Pharmacy Details

HEALTHSOURCE SEAMAN PHARMACY
CH05099Q HEALTHSOURCE OF OHIO, INC.

Covered Entity Details

Entity Name

HEALTHSOURCE OF OHIO, INC.

Subdivision Name

HealthSource Washington Court House

Type

HRSA-Funded Health Center

340B ID

CH05099Q

Entity Address

308 Highland Ave.
Washington Court House, OH 43160

Grant Number

H80CS00201

Participating Start Date

10/1/1998

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

HEALTHSOURCE SEAMAN PHARMACY

Pharmacy Address

218 STERN DRIVE
SEAMAN, OH 45679

Pharmacy Comments

Contract Details

Approval Date

11/10/2010

Contract Begin Date

12/1/2010

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/11/2018
Agreement registered in error

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

11/1/2010

340B Drug Pricing Program Database