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KROGER PHARMACY #730
CHC12878-00 BELINGTON COMMUNITY MEDICAL SERVICES ASSOCIATION, INC.
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Covered Entity Details
Entity Name
BELINGTON COMMUNITY MEDICAL SERVICES ASSOCIATION, INC.
Subdivision Name
BELINGTON MEDICAL CLINIC
Type
HRSA-Funded Health Center
340B ID
CHC12878-00
Entity Address
70 N STURMER ST
BELINGTON, WV 26250-9215
Grant Number
H80CS12878
Participating Start Date
7/1/2005
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #730
Pharmacy Address
450-11TH ST
ELKINS, WV 26241
Pharmacy Comments
Contract Details
Approval Date
4/9/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/6/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ERIC A. RUF, CEO
(304) 823-1333
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/9/2019
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