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KROGER PHARMACY 014907
DSH360003 University of Cincinnati Medical Center LLC
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Covered Entity Details
Entity Name
University of Cincinnati Medical Center LLC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360003
Entity Address
3188 Bellevue Avenue
CINCINNATI, OH 45219
Medicare Provider Number
360003
Participating Start Date
12/1/1992
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY 014907
Pharmacy Address
10477 HARRISON AVENUE
HARRISON, OH 45030
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
4/17/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RICK HINDS, Executive Vice President and Chief Financial Officer
(513) 585-8720
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/15/2019
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