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KROGER PHARMACY
CAH491304-00 CARILION ROCKBRIDGE COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
CARILION ROCKBRIDGE COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH491304-00
Entity Address
1 HEALTH CIRCLE
LEXINGTON, VA 24450
Medicare Provider Number
491304
Participating Start Date
8/30/2010
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY
Pharmacy Address
422 EAST NELSON DRIVE
LEXINGTON, VA 24450
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/20/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Greg Todd Madsen, VP
(540) 458-3590
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/14/2019
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