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KROGER PHARMACY L-884
CH04411Q UNITED NEIGHBORHOOD HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
UNITED NEIGHBORHOOD HEALTH SERVICES, INC.
Subdivision Name
MADISON FAMILY CLINIC
Type
HRSA-Funded Health Center
340B ID
CH04411Q
Entity Address
601 W Due West Ave
Madison, TN 37115-4423
Grant Number
H80CS00394
Participating Start Date
10/1/2009
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY L-884
Pharmacy Address
3410 GALLATIN RD
NASHVILLE, TN 37216
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary Bufwack, CEO
(615) 227-3000 Ext: 1024
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/15/2020
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