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HealthSource Mt. Orab Pharmacy
CH05099F HEALTHSOURCE OF OHIO, INC.
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Covered Entity Details
Entity Name
HEALTHSOURCE OF OHIO, INC.
Subdivision Name
HealthSource New Richmond
Type
HRSA-Funded Health Center
340B ID
CH05099F
Entity Address
100 RIVER VALLEY BLVD
NEW RICHMOND, OH 45157-8566
Grant Number
H80CS00201
Participating Start Date
10/1/1998
Last Recertification Date
2/10/2025
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
5/11/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
11/1/2010
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