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KROGER PHARMACY N-558
RRC360211-00 TRINITY HOSPITAL HOLDING COMPANY
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Covered Entity Details
Entity Name
TRINITY HOSPITAL HOLDING COMPANY
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360211-00
Entity Address
4000 JOHNSON ROAD
STEUBENVILLE, OH 43952
Medicare Provider Number
360211
Participating Start Date
4/1/2019
Last Recertification Date
8/23/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
KROGER PHARMACY N-558
Pharmacy Address
400 28TH STREET
BELLAIRE, OH 43906
Pharmacy Comments
Contract Details
Approval Date
4/14/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/27/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dave Werkin, CFO
(740) 264-8695
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/14/2019
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