Contract Pharmacy Details

DONOHOO PHARMACY INC
CH05099S HEALTHSOURCE OF OHIO, INC.

Covered Entity Details

Entity Name

HEALTHSOURCE OF OHIO, INC.

Subdivision Name

HEALTHSOURCE GEORGETOWN

Type

HRSA-Funded Health Center

340B ID

CH05099S

Entity Address

631 E STATE ST.
GEORGETOWN, OH 45121-1437

Grant Number

H80CS00201

Participating Start Date

10/1/1998

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

DONOHOO PHARMACY INC

Pharmacy Address

114 SOUTH MAIN STREET
GEORGETOWN, OH 45121-1292

Pharmacy Comments

12/28/2011 updated address

Contract Details

Approval Date

12/17/2010

Contract Begin Date

12/17/2010

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/22/2022
Ownership change

Contacts

Covered Entity Signing Official

William Marois, CFO
(513) 576-7700

Contract Pharmacy Representative

Donohoo Pharmacy
Bob Waters, Owner
(937) 378-4844

Signed By Date

11/1/2010