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KROGER PHARMACY L-588
RRC440073-00 Maury Regional Hospital
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Covered Entity Details
Entity Name
Maury Regional Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC440073-00
Entity Address
1224 Trotwood Ave
Columbia, TN 38401
Medicare Provider Number
440073
Participating Start Date
7/1/2013
Last Recertification Date
8/31/2021
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
KROGER PHARMACY L-588
Pharmacy Address
4726 TRADERS WAY
THOMPSONS STATION, TN 37179
Pharmacy Comments
Contract Details
Approval Date
1/22/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Deborah Lumpkins, Sr. VP/CNO
(931) 490-7118
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/22/2020
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