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KROGER LIMITED PARTNERSHIP I
CH070430 Big Springs Medical Association, Inc
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Covered Entity Details
Entity Name
Big Springs Medical Association, Inc
Subdivision Name
MISSOURI HIGHLANDS HEALTH CARE
Type
HRSA-Funded Health Center
340B ID
CH070430
Entity Address
110 SOUTH SECOND STREET
ELLINGTON, MO 63638-0157
Grant Number
H80CS00703
Participating Start Date
1/1/2004
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
KROGER LIMITED PARTNERSHIP I
Pharmacy Address
KROGER PHARMACY #386
2770 NORTH WESTWOOD
POPLAR BLUFF, MO 63901
Pharmacy Comments
Contract Details
Approval Date
10/13/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen R White, CEO
(573) 663-2313 Ext: 3965
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
10/13/2015
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