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KROGER PHARMACY L411
DSH180143 SAINT JOSEPH EAST
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Covered Entity Details
Entity Name
SAINT JOSEPH EAST
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180143
Entity Address
150 NORTH EAGLE CREEK DRIVE
LEXINGTON, KY 40509
Medicare Provider Number
180143
Participating Start Date
1/1/2008
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY L411
Pharmacy Address
179 WEST COLLEGE AVENUE
STANTON, KY 40380
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/26/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Eric Gilliam, President
(859) 967-5750
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/15/2019
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