340B Drug Pricing Program Database
KROGER PHARMACY #364
DSH490024 CARILION MEDICAL CENTER - information as of 4/25/2025 12:03:02 AM
Covered Entity Details
Entity Name
CARILION MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490024
Entity Address
1906 BELLEVIEW AVE SE
ROANOKE, VA 24014
Medicare Provider Number
490024
Participating Start Date
10/1/2007
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #364
Pharmacy Address
72 KINGSTON DR
DALEVILLE, VA 24083
Pharmacy Comments
Contract Details
Approval Date
10/24/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tim Auwarter, VP Hospital Operations
(540) 981-7804
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/24/2019
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