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KROGER PHARMACY L-355
CAH181328-00 ARH Mary Breckinridge Health Services, Inc.
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Covered Entity Details
Entity Name
ARH Mary Breckinridge Health Services, Inc.
Subdivision Name
Barbourville ARH Hospital
Type
Critical Access Hospital
340B ID
CAH181328-00
Entity Address
80 HOSPITAL DRIVE
BARBOURVILLE, KY 40906
Medicare Provider Number
181328
Participating Start Date
1/1/2016
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY L-355
Pharmacy Address
515 N 12TH STREET
MIDDLESBORO, KY 40965
Pharmacy Comments
Contract Details
Approval Date
7/7/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Grossman, PRESIDENT and CEO
(859) 226-2450
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/7/2020
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