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KROGER PHARMACY #215
CHC26516-01 Free Clinic Of The New River Valley Inc
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Covered Entity Details
Entity Name
Free Clinic Of The New River Valley Inc
Subdivision Name
Giles Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26516-01
Entity Address
219 Buchanan St
Pearisburg, VA 24134-1901
Grant Number
H80CS26516
Participating Start Date
10/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #215
Pharmacy Address
7480 LEE HIGHWAY
FAIRLAWN, VA 24141
Pharmacy Comments
Contract Details
Approval Date
9/3/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew Pitonyak, Chief Financial Officer
(540) 232-9960
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/15/2019
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