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KROGER PHARMACY CE 894
CHC26566-00 JANE PAULEY COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
JANE PAULEY COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Jane Pauley Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26566-00
Entity Address
8931 E. 30th Street
Indianapolis, IN 46219-1501
Grant Number
H80CS26566
Participating Start Date
4/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY CE 894
Pharmacy Address
8745 SOUTH EMERSON AVENUE
INDIANAPOLIS, IN 46237
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dale Marion, 340B Program Manager
(317) 552-0690
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/13/2020
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