An Ohio drug wholesale distributor and two former executives were charged on Thursday with profiting from the U.S. opioid epidemic by selling millions of pills despite signs the addictive drugs were being misused.

Federal prosecutors in Cincinnati charged Miami-Luken Inc and four people in the second U.S. criminal case against a drug distributor over its role in a crisis that has killed hundreds of thousands of people.

The indictment charged the Springboro, Ohio-based company; Anthony Rattini, its ex-president; James Barlay, Miami-Luken’s former compliance officer, and two pharmacists with conspiring to distribute controlled substances.

Prosecutors said Miami-Luken and the executives failed to guard against the dangerous drugs it shipped to pharmacies in five states from being diverted for illegal uses or to report suspicious orders to the U.S. Drug Enforcement Administration.

It shipped millions of pills to rural Appalachia, where the opioid epidemic was at its peak, including 3.7 million hydrocodone pills from 2008 to 2011 to a pharmacy in Kermit, West Virginia, a town of just 400 people, prosecutors said.

Two pharmacists who ordered drugs from Miami-Luken were also charged: Devonna Miller-West, the owner of Oceana, West Virginia-based Westside Pharmacy, and Samuel Ballengee, who ran Williamson, West Virginia’s Tug Valley Pharmacy.

James McQueen, a lawyer for Ballengee, said he believed he would be exonerated. The other defendants’ lawyers could not be identified. Miami-Luken last year discontinued operations.

The case is the latest to result from investigations into the extent drug manufacturers and distributors helping fuel the deadly opioid abuse epidemic.

From 1999 to 2017, 218,000 people died in the United States from overdoses related to prescription opioids, according to the U.S. Centers for Disease Control and Prevention.

Hundreds of lawsuits by states and cities have been filed nationally accusing drugmakers of deceptively marketing opioids and distributors such as AmerisourceBergen Corp, Cardinal Health Inc and McKesson Corp of ignoring suspicious orders.

Top executives from distributors as well as Miami-Luken were called to testify before a Congressional committee in May 2018 regarding the opioid epidemic. Asked if they contributed to it, only Miami-Luken’s then-chairman, Joseph Mastandrea, said yes.

Prosecutors said Miami-Luken, which closed in October, made more than $173 million in consolidated sales from 2008 to 2015 supplying drugs to 200 pharmacies in Ohio, West Virginia, Kentucky, Indiana and Tennessee.

Federal prosecutors in Manhattan in April brought the first opioid-related criminal case against a distributor, upstate New York’s Rochester Drug Co-operative Inc. The company paid $20 million to resolve the charges.