Contract Pharmacy Details

KROGER PHARMACY #792
DSH510055 Cabell Huntington Hospital, Inc.

Covered Entity Details

Entity Name

Cabell Huntington Hospital, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH510055

Entity Address

1340 Hal Greer Blvd.
Huntington, WV 25701-0195

Medicare Provider Number

510055

Participating Start Date

4/1/2005

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

KROGER PHARMACY #792

Pharmacy Address

2627 FIFTH AVENUE
HUNTINGTON, WV 25702

Pharmacy Comments

Contract Details

Approval Date

4/15/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

David M Ward, Sr. Vp/Cfo
(304) 526-2055

Contract Pharmacy Representative

Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875

Signed By Date

4/15/2019

340B Drug Pricing Program Database