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THE KROGER PHARMACY #858
DSH360025 FIRELANDS REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
FIRELANDS REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360025
Entity Address
1111 HAYES AVENUE
SANDUSKY, OH 44870
Medicare Provider Number
360025
Participating Start Date
1/1/2017
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
THE KROGER PHARMACY #858
Pharmacy Address
226 E. PERKINS AVE
SANDUSKY, OH 44870
Pharmacy Comments
Contract Details
Approval Date
7/6/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel J. Moncher, Executive Vice President & CFO
(419) 557-7793
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/6/2020
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