340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
KROGER PHARMACY #014722
DSH360239 SYCAMORE HOSPITAL
Print
Covered Entity Details
Entity Name
SYCAMORE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360239
Entity Address
4000 Miamisburg-Centerville Rd
MIAMISBURG, OH 45342
Medicare Provider Number
360239
Participating Start Date
1/1/2017
Last Recertification Date
9/10/2020
Entity Termination Date
4/1/2021
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #014722
Pharmacy Address
10101 LANDING WAY
MIAMISBURG, OH 45342
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brent Davis, CFO
(937) 395-8688
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/15/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session